Exploring trainer and trainee emotional talk in narratives about workplace-based feedback processes.

Emotion characterises learners' feedback experiences. While the failure-to-fail literature suggests that emotion may be important, little is known about the role of emotion for educators. Secondary analyses were therefore conducted on data exploring 110 trainers' and trainees' feedback experiences. Group and individual narrative interviews were conducted across three UK sites. We analysed 333 narratives for emotional talk using textual analysis: Linguistic Inquiry and Word Count. Furthermore, thematic framework analysis was conducted on the trainer narratives to explore aspects of feedback processes that are emotional. An additional in-depth little 'd' discourse analysis was conducted on selected trainer narratives to enable us to explore the complex relationship between the whats (reported events) and the hows (emotional talk). Trainer narratives did not differ significantly in positive or negative emotional talk from trainee narratives. By exploring the interplay of the whats and the hows, several aspects of feedback processes were identified as potentially emotional for trainers including trainers being concerned about upsetting learners and worried about patient safety. This was illustrated through numerous linguistic devices to establish emotional tone such as metaphoric talk and laughter. These findings suggest that feedback processes can be emotional for trainers. It highlights the need to better understand the 'filter' of emotion for trainers but also to better understand how emotion plays a role in feedback as a complex social process.

The 'three-legged stool': a system for spinal informed consent.

Many hospitals do not have a structured process of consent, the attainment of which can often be rather 'last-minute' and somewhat chaotic. This is a surprising state of affairs as spinal surgery is a high-risk surgical specialty with potential for expensive litigation claims. More recently, the Montgomery ruling by the United Kingdom Supreme Court has placed the subject of informed consent into the spotlight. There is a paucity of practical guidance on how a consent process can be achieved in a busy clinical setting. The British Association of Spinal Surgeons (BASS) has convened a working party to address this need. To our knowledge this is the first example of a national professional body, representing a single surgical specialty, taking such a fundamental initiative. In a hard-pressed clinical environment, the ability to achieve admission reliably on the day of surgery, in patients at ease with their situation and with little likelihood of late cancellation, will be of great benefit. It will reduce litigation and improve the patient experience. Cite this article: Bone Joint J 2016;98-B:1427-30.

Management characteristics, lameness, and body injuries of dairy cattle housed in high-performance dairy herds in Wisconsin.

The objective of this study was to benchmark the prevalence of lameness, hock and knee injuries, and neck and back injuries among high-performance, freestall-housed dairy herds in Wisconsin. A random selection of 66 herds with 200 or more cows was derived from herds that clustered with high performance in year 2011 Dairy Herd Improvement records for milk production, udder health, reproduction, and other health parameters. Herds were surveyed to collect information about management, facilities, and well-being. Well-being measures were obtained through direct observation of the high-producing mature cow group, surveying 9,690 cows in total. Total herd size averaged (mean ± standard deviation) 851±717 cows, ranging 203 to 2,966 cows, with an energy-corrected milk production of 40.1±4.4kg/cow per day. Prevalence of clinical lameness (5-point scale, locomotion score ≥3) and severe lameness (locomotion score ≥4) averaged 13.2±7.3 and 2.5±2.7%, respectively. The prevalence of all hock and knee injuries, including hair loss, swelling, and ulceration, was similar at 50.3±28.3 and 53.0±24.0%, respectively. Severe (swelling and ulceration) hock and knee injury prevalence were 12.2±15.3 and 6.2±5.5%, respectively. The prevalence of all neck injuries (including hair loss, swelling and ulceration) was 8.6±16.3%; whereas the prevalence of swollen or abraded necks was low, averaging 2.0±4.1%. Back injuries (proportion of cows with missing or abraded spinous processes, hooks, or pins) followed a similar trend with a low mean prevalence of 3.6±3.4%. Overall, physical well-being characteristics of this selection of high-producing, freestall-housed dairy herds provide evidence that lameness and injury are not inevitable consequences of the confinement housing of large numbers of dairy cattle. In particular, lameness prevalence rivals that of lower-production grazing systems. However, hock and other injury risk remains a concern that can be addressed through a choice in stall surface type. Use of deep, loose bedding yielded significant advantages over a mat or mattress type surface in terms of lameness, hock and knee injury, and proportion of cows with dirty udders (distinct demarcated to confluent plaques of manure). The performance benchmarks achieved by these herds may be used to set standards by which similarly managed herds may be judged using welfare audit tools.

Informed consent: where are we in 2015?

A recent Supreme Court ruling in the United Kingdom has significantly altered the emphasis of informed consent, moving from a historically 'doctor-focused' to a more 'patient-focused' approach, in line with the situation in other international jurisdictions. The reasons for the change are discussed with some recommendations about how our attitudes need to change in the future. Cite this article: Bone Joint J 2015;97-B:1159-61.

Survey of facility and management characteristics of large, Upper Midwest dairy herds clustered by Dairy Herd Improvement records.

A survey of management practices was conducted to investigate potential associations with groupings of herds formed by cluster analysis (CA) of Dairy Herd Improvement (DHI) data of 557 Upper Midwest herds of 200 cows or greater. Differences in herd management practices were identified between the groups, despite underlying similarities; for example, freestall housing and milking in a parlor. Group 6 comprised larger herds with a high proportion of primiparous cows and most frequently utilized practices promoting increased production [e.g., 84.4% used recombinant bovine somatotropin (rbST)], decreased lameness (e.g., 96.9% used routine hoof trimming for cows), and improved efficiency in reproduction [e.g., 93.8% synchronized the first breeding in cows (SYNCH)] and labor (e.g., mean ± SD, 67 ± 19 cows per 50-h per week full-time equivalent worker). Group 1 had the best mean DHI performances and followed most closely group 6 for the rate of adoption of intensive management practices while tending to outperform group 6 despite a generally smaller mean herd size (e.g., 42.3 ± 3.6 kg vs. 39.9 ± 3.6 kg of energy-corrected milk production; 608 ± 352 cows vs. 1,716 ± 1,405 cows). Group 2 were smaller herds with relatively high levels of performance that used less intensive management (e.g., 100% milked twice daily) and less technology (33.3 vs. 73.0% of group 1 used rbST). Group 4 were smaller but poorer-performing herds with low turnover and least frequently used intensive management practices (e.g., 39.1% SYNCH; 30.4% allowed mature, high-producing cows access to pasture). Group 5 used modern technologies and practices associated with improved production, yet had the least desirable mean DHI performance of all 6 groups. This group had the lowest proportion of deep loose-bedded stalls (only 52.2% used sand bedding) and the highest proportion (34.8%) of herds not using routine hoof trimming. The survey of group 3 herds did not reveal strong trends in management. The differences identified between herd groupings confirm significant variation in management practices linked to variation in overall herd performance measured by DHI variables. This approach provides an opportunity for consultants and outreach educators to better tailor efforts toward a certain type of dairy management philosophy, rather than taking a blanket approach to applying recommendations to farms simply because of their larger herd size.

Differential stimulation of monocytic cells results in distinct populations of microparticles.

BACKGROUND: Microparticles (MPs), small vesicles shed from stimulated cells, permit cross-talk between cells within a particular environment. Their composition is thought to reflect their cell of origin, and differs according to whether they are produced by stimulation or by apoptosis. Whether MP properties vary according to stimulus is not yet known. METHODS: We studied the characteristics of MPs produced from monocytic THP-1 cells upon stimulation with lipopolysaccharide or a soluble P-selectin chimera, using proteomics, flow cytometry, western blotting, and electron microscopy. RESULTS: Utilizing a novel criterion of calcein-AM staining to define MPs, we found that MP populations were similar with respect to size, presence and organization of cytoskeleton, and expression of certain antigens. The MPs shared the same level of procoagulant activity. We found that MPs also have distinct characteristics, depending on stimuli. These include differences in phosphatidylserine expression and expression of proteins from specific subcellular locations such as the mitochondria, and of unique antigens such as leukocyte-associated immunoglobin-like-receptor (LAIR)-1, which was found only upon stimulation with the soluble P-selectin chimera. CONCLUSION: We found that the properties of MPs depend on the stimulus that produced them. This supports the concept that monocytic MPs differentially modulate thrombosis, inflammation and immune regulation according to stimulus.

Recent advances in the characterisation of the platelet membrane system by proteomics.

Platelets are the principle effectors of cellular haemostasis and key mediators in the pathogenesis of thrombosis. A variety of membrane receptors determine platelet reactivity with numerous agonists and adhesive proteins, and therefore represent key targets for the development of antiplatelet drug therapy. Here, we summarise recent advances in the analysis of the complex platelet membrane system achieved through the integration of platelet biology and proteomics.

Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer.

BACKGROUND: Women with breast cancer are more frequently being treated with preoperative neoadjuvant chemotherapy. The reliability of sentinel lymph node biopsy (SLNB) following chemotherapy has not been determined. This was a meta-analysis of studies that examined the results of SLNB after preoperative chemotherapy. METHODS: Included articles had to meet two criteria. First, patients had to have had operable breast cancer and to have undergone SLNB after preoperative chemotherapy and, second, patients had to have undergone subsequent axillary lymph node dissection. Meta-analyses were performed in which Bayesian hierarchical models were created to estimate the identification rate (IR) and sensitivity of SLNB in this setting. RESULTS: Twenty-one studies were identified that included a total of 1273 patients. The IRs reported ranged from 72 to 100 per cent, with a pooled estimate of 90 per cent. The sensitivity of SLNB ranged from 67 to 100 per cent, with a pooled estimate of 88 (95 per cent confidence interval 85 to 90) per cent. Meta-analyses performed using Bayesian modelling resulted in (posterior) estimates for IR and sensitivity of 91 (95 per cent credible interval 88 to 94) and 88 (95 per cent credible interval 84 to 91) per cent respectively. CONCLUSION: SLNB is a reliable tool for planning treatment after preoperative chemotherapy.

Using proteomics to identify potential therapeutic targets in platelets.

Proteomics has provided powerful new insights into the complex events of the anucleate platelet and has revealed many potential protein targets in the search for suitable agents for thrombotic disease. In the present study, we summarize recent proteomic approaches to analyse specific platelet subproteomes, such as the platelet releasate, the platelet phosphotyrosine proteome and characterization of the proteins associated with membrane lipid rafts.

Excision of a bony spike without fixation of the fractured clavicle in a jockey.

Various modalities are available for treatment of a clavicle fracture. Conservative treatment is successful in most cases. Open reduction, when indicated, usually is accompanied by fixation of the fracture. In the case of a jockey with a fractured clavicle, the fracture was complicated by tenting of the skin. The fracture was opened and a bony spike was excised extraperiosteally without doing internal fixation of the fracture to avoid skin necrosis and allow early return to work. The patient returned to his profession 2 weeks after surgery. Radiologic and clinical examinations revealed a satisfactory outcome at the 6-month followup.

17beta-estradiol: effect on CA1 hippocampal synaptic plasticity.

An understanding of synaptic plasticity in the mammalian brain has been one of R. F. Thompson's major pursuits throughout his illustrious career. A current series of experiments of significant interest to R. F. Thompson is an examination of the interactions between sex hormones, synaptic plasticity, aging, and stress. This research is contained within a broader project whose aim is to investigate animal models that evaluate estrogen interactions with Alzheimer's disease. This paper reviews the recent results that have led to a better understanding of how the sex hormone estrogen influences synaptic plasticity in an important structure within the mammalian brain responsible for learning and memory: the hippocampus. In this review, a number of experiments have been highlighted that investigate the molecular mechanisms that underlie estrogen's effect on two specific forms of synaptic plasticity commonly studied in neurophysiology and the behavioral neurosciences: long-term potentiation and long-term depression.

Direct explanations for the development and use of a multi-layer perceptron network that classifies low-back-pain patients.

Using a new method published by the first author, this article shows how direct explanations can be provided to interpret the classification of any input case by a standard multilayer perceptron (MLP) network. The method is demonstrated for a real-world MLP that classifies low-back-pain patients into three diagnostic classes. The application of the method leads to the discovery of a number of mis-diagnosed training and test cases and to the development of a more optimal low-back-pain MLP network.

Cyclic changes in estradiol regulate synaptic plasticity through the MAP kinase pathway.

Hippocampal synaptic structure and function exhibit marked variations during the estrus cycle of female rats. Estradiol activates the mitogen-activated protein (MAP) kinase pathway in numerous cell types, and MAP kinase has been shown to play a critical role in the mechanisms underlying synaptic plasticity. Here, we report that endogenous estrogen produces a tonic phosphorylation/activation of extracellular signal-regulated kinase 2 (ERK2)/MAP kinase throughout the female rat brain and an increase in tyrosine phosphorylation of NR2 subunits of N-methyl-D-aspartate (NMDA) receptors. Moreover, cyclic changes in estrogen levels during the estrus cycle of female rats are associated with corresponding changes in the levels of activation of ERK2, the state of tyrosine phosphorylation of NR2 subunits of NMDA receptors, and the magnitude of long-term potentiation in hippocampus. Thus, cyclic changes in female sexual hormones result in marked variations in the state of activation of a major cellular signaling pathway critical for learning and memory and in a cellular model of learning and memory.

Oral extrusion of a screw after anterior cervical spine plating.

STUDY DESIGN: A case report of a 76-year-old woman who retched up a screw from a cervical spine locking plate 5 years after anterior cervical spine fusion. The literature relevant to this topic is reviewed. OBJECTIVES: To report the rare but potentially life-threatening complication of oral screw extrusion after anterior cervical spine plating, to review the relevant literature on the topic, and to discuss the clinical management of instrumentation failure in anterior cervical spine plating. SUMMARY OF BACKGROUND DATA: Anterior cervical spine fusion and stabilization is a well-established procedure. Complications include instrumentation failure, which can progress to extrusion through the gastrointestinal tract. Management is dependent on the severity and progression of clinical and radiologic signs and symptoms. Reoperation should be considered in certain cases. METHODS: A rare complication of anterior cervical spine plating in a 76-year-old woman 5 years after the initial operation is reported. The patient was assessed with serial physical examination and radiograph and one further follow-up 3 months after the first presentation. RESULTS: The patient was asymptomatic shortly after she retched up the screw, and at the 3-month follow-up was without evidence of progression of plate dislodgement. CONCLUSION: As reported, oral extrusion of cervical spine grafts or instrumentation is rare but potentially serious. Each case of instrumentation failure should be assessed individually to decide if conservative management is appropriate or if reoperation should be considered.

Graf ligament stabilisation: mid- to long-term follow-up.

Previous studies have looked at early follow-up of the Graf ligament stabilisation system. We present mid- to long-term results of this procedure. A retrospective review of Graf ligaments inserted since 1993 was undertaken. A total of 51 patients were reviewed. Pre-operative Oswestry Disability Index scores were compared to post-operative scores recorded via a postal questionnaire. There were 28 men and 23 women. The average age was 41 years (range, 2267 years). The mean pre-operative score was 46 (range, 22-78), the mean follow-up time was 51 months (range, 23-84 months) and the mean post-operative score was 40 (range, 0-82). There were 12 complications (4 requiring further surgery), and seven patients went on to require bony fusion procedures. Forty one per cent of the group would choose not to have the operation again. Longer-term results of this technique are not as encouraging as earlier studies. The continued use of this procedure should be viewed with caution.

Gene expression analysis by massively parallel signature sequencing (MPSS) on microbead arrays.

We describe a novel sequencing approach that combines non-gel-based signature sequencing with in vitro cloning of millions of templates on separate 5 microm diameter microbeads. After constructing a microbead library of DNA templates by in vitro cloning, we assembled a planar array of a million template-containing microbeads in a flow cell at a density greater than 3x10(6) microbeads/cm2. Sequences of the free ends of the cloned templates on each microbead were then simultaneously analyzed using a fluorescence-based signature sequencing method that does not require DNA fragment separation. Signature sequences of 16-20 bases were obtained by repeated cycles of enzymatic cleavage with a type IIs restriction endonuclease, adaptor ligation, and sequence interrogation by encoded hybridization probes. The approach was validated by sequencing over 269,000 signatures from two cDNA libraries constructed from a fully sequenced strain of Saccharomyces cerevisiae, and by measuring gene expression levels in the human cell line THP-1. The approach provides an unprecedented depth of analysis permitting application of powerful statistical techniques for discovery of functional relationships among genes, whether known or unknown beforehand, or whether expressed at high or very low levels.

The tyrosine kinase and mitogen-activated protein kinase pathways mediate multiple effects of estrogen in hippocampus.

Estrogen replacement therapy in women is associated with improvement of cognitive deficits and reduced incidence of Alzheimer's disease. The present study indicates that estrogen is neuroprotective against N-methyl-d-aspartate (NMDA)- and kainate-mediated neurotoxicity, an effect mediated by tyrosine kinase/mitogen-activated protein kinase (MAPK) pathways. Estrogen also stimulates tyrosine phosphorylation of NMDA receptors via an src tyrosine kinase/MAPK pathway. Finally, estrogen-mediated enhancement of long-term potentiation in hippocampal slices is mediated by activation of an src tyrosine kinase pathway. Thus, estrogen, by activating an src tyrosine kinase and the extracellular signal-related protein kinase/MAPK signaling pathway, both enhances NMDA receptor function and long-term potentiation and retains neuroprotective properties against excitotoxicity. These findings warrant further evaluation of the usefulness of estrogenic compounds for the treatment of Alzheimer's disease and other neurodegenerative diseases.

Treatments used in women with interstitial cystitis: the interstitial cystitis data base (ICDB) study experience. The Interstitial Cystitis Data Base Study Group.

OBJECTIVES: To evaluate the frequency and types of treatments reported at baseline in women who entered the Interstitial Cystitis Data Base (ICDB) cohort study. METHODS: From 1993 to 1997, 581 women were enrolled and followed in the ICDB. All treatments reported at study entry, including those prescribed for interstitial cystitis (IC) and concomitant medications, were reviewed. The number and types of treatments were evaluated with respect to baseline factors such as prior diagnosis of IC and symptom severity. RESULTS: One hundred five (18%) women were receiving no therapy at baseline. Single-mode therapy was reported by 195 (34%) women, and a combination of two treatments was reported by 119 (21%) women. Three or more treatments were reported in 162 (28%) women. A total of 183 different types of therapies were recorded. The five most commonly used therapies for IC symptoms were cystoscopy and hydrodistention, amitriptyline, phenazopyridine, special diet, and intravesical heparin. Because most patients entered the ICDB before the approval of oral pentosan polysulfate sodium (PPS), only 6% of women reported oral PPS use at baseline. There were statistically significant associations between the number and types of treatments and clinical center, a prior diagnosis of IC, and symptom severity. CONCLUSIONS: The diversity of IC therapies underscores the lack of understanding about the treatment of this syndrome. Further research in IC is essential to develop and to evaluate rational therapies and treatment algorithms. These algorithms should be "evidence based" and should be revised as the underlying etiology and pathophysiology of IC is delineated.

17beta-estradiol suppresses expression of long-term depression in aged rats.

It has been recently reported that the female steroid hormone 17beta-estradiol enhances synaptic transmission and the magnitude of long-term potentiation (LTP) in adult rodent hippocampus. Moreover, 17beta-estradiol ameliorates cognitive and memory function in postmenopausal women. Since aging is associated with an alteration of synaptic plasticity (e.g., higher susceptibility to long-term depression [LTD]), we examined whether 17beta-estradiol alters the expression of LTD in aged rats. We now report that the induction of LTD recorded from CA1 hippocampal neurons of aged rats is suppressed by 17beta-estradiol treatment, which produced only a minimal effect in suppressing LTD in adult rats. These results suggest that estrogen may act to improve memory by suppressing forgetfulness via a synaptic mechanism, such as LTD.