bluuebunny/crossref_metadata_2025 huggingface dataset:
P66 Developing and supporting management and leadership within a hospice
Authors: Kennedy Joanna , McClinton Pam , Thomas Joette , Wallace Duncan
Published: October 2013

This abstract outlines the innovative way the North London Hospice sought to improve the effectiveness of all of its leadership and management practice using values as a bedrock.

From 2011 – 2013, the Animate team developed and ran a management development programme for all 31 managers from across. The purpose of the programme was to provide an integrated learning opportunity that strengthened the skills, understanding and effectiveness of the management of the Hospice

The design of the programme paid attention to the environment in which the staff worked. A wide variety of issues were raised for them which had implications for creating a system of management and leadership which truly integrates core values throughout the organisation and into all aspects of care.

The programme enabled participants to analyse their own experience using a collection of theories and frameworks, which deepened their understanding of their role. It addressed the particular management challenges of working in hospice setting where staff are mostly highly motivated, passionate, inclined to work very hard and exposed to a high degree of emotion in the course of their day. It included both opportunities to reflect through action learning and focused action planning.

Six months after the end of the programme the Executive Team were seeing the impact on management practice. They were noticing managers broadening and adapting their leadership styles to suit different situations. They also observed tools and frameworks being successfully used to analyse difficult problems and plan new initiatives. They were seeing managers being more confident and clearer about what their role involved. The greatest impact was on opening up and deepening learning across departments, disciplines and teams.

Animate has now teamed up with the North London Hospice to design and deliver programmes in other hospices tailoring the content to meet particular contexts.
P67 Using a service evaluation to drive change and improve quality
Authors: Newman Peter , White Jane , Plowman Martin
Published: October 2013

Introduction

Dreams Come True is a national charity providing dreams for children age 2–21 with life-threatening and life-limiting conditions. As part of our overall commitment in our 25th year to improving the quality of our dream delivery service, we have embarked on a programme of service improvement. Voluntary organisations have a key role to play in palliative care pathways and it is important that the sector is a serious partner in the drive to improve services.

Aim

The starting point was an independent service evaluation designed to evaluate the views of all our stakeholders: the internal team; the key professionals who refer to our service; and most importantly the families that we serve.

Methods

The study methodology used a combination of nominal group technique for parents and staff team and email survey among key referring informants.

Results

This paper will focus on the lessons learned by the charity in undertaking the study and will describe the process of internal review, re-evaluation and implementation of change that has now been actioned. Such changes include ways in which we will be involving families and communications practices with professionals as well as a re-evaluation of our services to young adults in transition.

Conclusion

We will describe the ongoing methods by which we will monitor the impact of those changes which we hope will achieve quality improvements to all stakeholders in our organisation. It will be of interest to other voluntary organisations supporting palliative care services nationwide especially those considering undertaking a service evaluation. It will also be of interest to children’s hospitals and hospices with an interest in the professionalism and effectiveness of the service delivery of such voluntary organisations.
09 Use of video consultation at the end of Life - supporting care at home
Authors: Malin Rebecca , Wilson Linda , Pope Richard
Published: October 2013

Introduction

People at the end of life (and their carers) require support on a 24/7 basis. Access to appropriate, immediate advice is important to optimse the quality of care, reduce anxieties and where appropriate avoid hospital admission. Use of video links to the home may allow such services to be delivered in a scalable and affordable way.

Aims

To develop reliable means of deploying high quality video links between hospices and a person’s own home or residential care setting.

Methods

Using standards based, resilient videoconferencing, running over domestic broadband, links were established between a hospice and patients receiving support at home and in a range of residential care settings. The service also linked patients to the local acute hospital’s teleconsultation centre. Staff at the hospice and patients/carers were able to both make and receive calls at any time. Proof of concept outcome measures included the ability to create a stable video link in a domestic setting and identification of clinical use cases where video enabled safe, appropriate care delivery. Qualitative indications of patient, carer and staff satisfaction with the approach were also recorded.

Results

Where broadband speed exceeded 500kb/s (up and download) we established reliable video connexions in all cases. Service users were able to receive general symptom control and treatment advice, it was possible to avoid need for admission or to expedite admission when necessary. Staff and patient satisfaction with the approach was high, averaging 8.5/10 across a range of measures. The service is expanding to include links to all local Nursing Homes and to allow on-call palliative care consultants to join calls from their own home.

Conclusion

Use of video-consultation to the home enables immediate delivery of palliative care support without need for travel and may avoid the need for some hospital admissions. The approach is valued by users.
P68 Lean - Looking with fresh eyes
Authors: Bridger Susan , Collins Debbie , Loan Rebecca , Tomsett Jacqui
Published: October 2013

Introduction

The hospice has continually strived to provide the most efficient and streamlined services possible, right across the organisation. In August 2011 in was decided to introduce ‘Lean’.organisational improvement principles. 4 staff from different departments were trained as Lean Advisers to embed the principles of Lean within all areas of the hospice.

This is the journey of the introduction and development of ‘Lean’ to support organisational improvement.

Aim

To demonstrate the development of the role of the ‘LEAN’ Advisers to empower and support staff in their review of departmental processes using ‘LEAN’ principles and techniques.

To discuss process and outcomes of projects undertaken in clinical care, fundraising, staff support and environmental efficiency

To discuss lessons learnt

To discuss where we go from here

Methods

Developed a timeline to plot the journey to introduce Lean Principles.

Ongoing training provided on a voluntary basis by a Lean consultant

Use of a variety of Lean tools to collect and analyse data

Results

To date two projects have been completed - 1 reviewing and streamlining of the patients journey through the hospice which has resulted in cost savings on staffing and an increase in patient contacts by community staff. 2 the running and management of OT & Physio equipment stores which has resulted in a more efficient and safer service to patients. 3 other projects are in progress.

Conclusion

It is far too easy to offer solutions to a problem before understanding what is really going on

It is far too easy to implement a process/solution for a problem and then think the job is done

A group of people from different backgrounds with LEAN training can make a massive difference to a service
P69 Recruiting our workforce using value based interviewing
Authors: Power Rachel
Published: October 2013

National research and enquires have highlighted a gap between the espouced values within care environments and the quality of care people receive. Richard House recognises the relationship between high quality care and the values and attitudes of staff and volunteers.

Richard House implemented value based interviewing (VBI) as part of our recruitment process in 2012 to seek to ensure that the values of Richard House are reflected in the day to day care and support it provides to children, young people and their families.

Core values were drawn up by the staff and volunteers who also helped develop the positive and negative indicators.

Value Based Interviewing is underpinned by robust research and it has been proven this interviewing method facilitates the recruitment of people more aligned with organisational values and behaviours and helps recruit high performing and effective staff and volunteers.

VBI has been used and established in a number of organisations including the NSPCC. It has been shown to effectively identify candidates who are a “better fit” for Richard House and therefore the right people to support the service for children young people and their families.
P70 Developing and celebrating good practice in a hospice setting: equipping a workforce for a changing and uncertain future
Authors: Griffith Sue , Powis Kate
Published: October 2013

Background

In the current climate of austerity and need to demonstrate that hospices are able to prepare for a changing future of widening access, it is important that hospices take every opportunity to develop practice and ensure the whole workforce is abreast of current thinking. Furthermore, this development must be made explicit to staff and all stakeholders. Having always prided itself on being a centre of excellence, this hospice sought to demonstrate this by being recognised as a practice development unit.

Approach

After working with a university to reach first stage accreditation, it was acknowledged that the framework to achieve this was too rigid and costly for a charitable organisation. The existing education and research group was amalgamated with the practice development team to create a Hospice Education And Research and Development (HEARD) group to ensure that every aspect of hospice care follows a practice development approach.

Outcomes

The group HEARD offers everyone in the organisation a voice, and a place for their development ideas to be heard. It meets bi-monthly to examine current practice, ideas for research and publication, and to plan a series of learning events to meet changing educational needs of all hospice staff. This plans to generate evidence, develop practice, disseminate good practice, and share best evidence through a journal club, with a focus on developing the workforce and leadership abilities through a largely bottom-up approach.

Application

To preserve the academic rigour of the practice development process, eight criteria were created to guide innovation, and the group has a steering committee. Two successful celebration days have now been held to showcase practice developments to stakeholders and staff. An electronic source of educational information has developed from this; the research behind which, as well as other developments, have been published and shared at international conferences.
P71 Intergrating a new hospice pay policy with a nursing competency framework
Authors: Bacon Ruth , Schrikker Tara , Clarke Karen
Published: October 2013

Introduction

The hospice decided to formulate a new nursing pay structure which moved away from Agenda for Change principles and integrated an updated competency framework.

Aims

Create a pay policy to reflect local market conditions and respond to hospice needs whilst being flexible

Develop a “balanced” nursing skill mix which reflects the hospice’s needs

Establish core requirements for each nursing post

Link competence with pay

Develop a pay and competence framework in consultation with staff.

Method

Using best practice documents, the hospice reviewed and updated existing competencies before implementation.

Registered Nurses engaged with the new process by:-

Attending teaching sessions on

Introduction to Competencies: How, What, Why and When!

Getting Started with your Competencies

Meeting with Line Managers on a 1:1 basis

A structure consisting of Foundation, Intermediary and Tenure levels of competency and pay was introduced.

Results

The implementation of a competence related pay structure appears to have had a positive effect on staff engagement and motivation. Improved awareness, communication, education and support have resulted.

Staff feel more confident working at the competency level which reflects their experiences and skills.

Conclusion

Having the competencies linked into Performance Development Review process enables a cycle of reflection, support, training and evaluation.

The framework encourages and supports staff to work to their potential to provide specialist palliative care and respond to organisational needs.
P72 Leaving home - managing change
Authors: Clarke Karen
Published: October 2013

Background

Autumn 2013 the hospice will relocate to its new 20-bedded facility. To have a successful move staff/volunteers need to feel supported and engaged.

Aim

Change Management Strategy was implemented to:

generate interest, energy and enthusiasm

empower managers to take ownership and problem solve

engage employees, patients and their families

implement the practical steps to ensure safe working practices

attract and retain new employees and volunteers whilst ensuring low turnover.

Approach

Staff Engagement questionnaire (September 2011) assessed staffs’ preparedness for change.

Change management programme developed based upon Kotter, Lewin and Kübler-Ross.

Communication - briefings; hospice newsletter; team meetings; 1:1’s; Away Days.

Patients Forum worked with the Deputy CEO on all aspects of the new hospice since June 2011.

September 2012 - Day Therapy patient group focused on the new Wellbeing Centre.

Staff/volunteers involvement:

site visits

Farewell Project

furniture and equipment consultation

piloting proposed changes

planning decant strategy

charting hospice’s history

developing operational plans

developing orientation/induction programme.

Outcomes

77 volunteers have confirmed they will relocate

<10 staff indicated they will not be relocating

Site visit feedback:

“gives a feeling of being involved in the change process literally from ‘the ground up’”

“incredibly inspiring …really helped to bring the vision to life….will help immensely when having discussions with staff, patients and relatives about the new hospice.”

Further outcomes available post move.

Application

At a time of unprecedented change in the hospice movement it is important not to lose sight of the impact on staff and volunteers:

“One of the greatest costs of change is that impact on the ability of staff to respect and care for others while they feel under threat themselves.” (Iles 2005).
P73 Does the attachment style of hospice workers predict their emotional response to a move into a bespoke new build unit?
Authors: Meystre Chantal , Murray Jane , Armour Kathy
Published: October 2013

Aim

To investigate the relationship between psychological attachment style and emotional responses to moving into a purpose built hospice.

Background

Mental representations of self and other are formed by our primary relationship. Internal working models inform subsequent relationships, world view and responses to life events. Attachment style research demonstrates predictive value for staff responses in clinical environments. In 2013 our hospice service relocated to a bespoke new build. Practical issues were addressed by project management, but psychological and emotional aspects were unexplored.

Methodology

After favourable University ethics review the study took place in an English, 17 bedded consultant-led hospice with daycare, and community services. All staff and visiting volunteers were eligible for the study. A modified adult attachment questionnaire with added elements was circulated prior to moving. Gender was not collected to ensure confidentiality.

Results

42 questionnaires (31%) were returned: 34 staff, 8 volunteers. Statistical analysis revealed no difference between staff and volunteers so they are reported together. The median length of service at the old Hospice was 6.2 years; range <1 to 23 years service. Older staff had worked for the hospice for longer (p < 0.05).

Anxious and avoidant attachment styles were not related to length of service in the hospice. Staff with anxious attachment styles grieved more (p < 0.003) and felt it was wrong to sell the old hospice (p < 0.05). Both anxious and avoidant staff with higher scores were less likely to want to move (p < 0.05).

Conclusions and Applications to Hospice practice

Our data suggest that attachment style is stable despite the stress of working in a hospice environment. As in other workplaces anxiously attached personnel have predictably more negative emotional responses to life events. This is useful information for staff care and suggests some groups of staff may benefit from targeted clinical supervision during periods of great change.
P74 Tears at the wedding
Authors: Sadler Clair , Nolan Steve , Sansom Gill , Warren Linda , Cox Linda , Cullen Anne
Published: October 2013

Background

A diagnosis of cancer can mean that the ‘taken for granted’ future is disrupted which impacts on self-image and social roles. People may strive to contribute to a meaningful life (Armstrong-Coster, 2004) and develop contingencies to preserve their sense of self-identity so remain within their social worlds (Becker, 1997). In their everyday work, hospice staff face tensions and conflicts within families as well as the loss of anticipated social roles for their patients. In the case presented, the anticipated social role of wife in a young dying women brought into focus personal and professional unity and conflict for hospice staff.

Aims

To explore the challenges of a hospice responding to a families wishes by organising a wedding for a dying woman: whose needs are we meeting?

Methods

Through the medium of a Schwartz Centre Round 4 members of hospice staff presented their contrasting experiences and feelings evoked by hospice weddings. In keeping with the SCR, a multidisciplinary discussion was then opened up to staff.

Results

The juxtaposition of different professional and personal beliefs and values was explored and the challenge of how to manage complex social dynamics of meeting the patient’s and family’s needs when death is a spectre at the wedding celebration. The discussion focused on opposing views of whose needs are the most pressing: the dying woman or the needs of a caring family anticipating bereavement.

Conclusion

Resolution is not the aim of the SCR but open, honest conflict and discussion in a confidential environment allowed the ‘unspeakable’ to be spoken. In dealing with such complex issues in a hospice setting, the SCR allows an effective means of exploration not necessarily resolution.

Application to hospice practice

Schwartz Centre Rounds are protected time to allow hospice staff the space to explore socially and emotionally difficult situations.
P75 “You’re a little part of a jigsaw. Going to schwartz centre rounds, you see the other bits of the jigsaw”
Authors: Knight Andrew , Cullen Anne , Todd Jennifer , Reed Liz , Sadler Clair , Gannon Craig
Published: October 2013

Background

Schwartz Centre Rounds (SCR) offer healthcare providers a protected time to talk openly and honestly about situations in their work that challenge them on a human level. Evidence suggests that SCR’s strengthen team working and are valuable to the healthcare providers which translates to the care they offer their patients1.

In 2012, Princess Alice Hospice was one of the first hospices in the UK to adopt SCR’s and opened the rounds to both clinical and non-clinical staff and volunteers. Presenters have included nurses, doctors, housekeeping staff, healthcare assistants, trustees and volunteers.

Aim

To explore in detail the experience of multidisciplinary staff and volunteers of SCR’s in a UK hospice after one year.

Methods

A mixed method approach triangulating quantitative evaluation data from the first year and qualitative data from 3 focus groups (presenters, attendees and non-attendees). Categorical indexing was generated from the topic guide themes and sub-categories generated within the identified key themes2.

Results

Over the year SCR’s have had a mean attendance of 46 people (range 37-57). They are consistently well evaluated with 90.5% gaining knowledge helpful in their work, 98.2% gaining insight into how others think/feel in caring for patients and 85.1% feeling the SCR will help them work better with colleagues. Twenty six people attended three focus groups. Each group was representative of clinical and non-clinical staff as well as volunteers. General themes: values and challenges of an inclusive multidisciplinary SCR; appreciating the roles and experience of others; time and commitments; dissonance between the personal and professional self; safety versus exposure; and communicating about Schwartz in a UK Hospice.

Conclusion

Overall,SCR’s are well valued at Princess Alice Hospice influencing individuals in their everyday work and working relationships. Issues around communication, format and representation have been taken forward to further develop SCR’s at the Hospice.
P76 Rags to revenue
Authors: Midgley Rowena
Published: October 2013

A pilot scheme was set up in September 2012 to re-evaluate our current textile recycling process, which was selling all the Rags* from our retail shops onto textile recyclers. This scheme examined the possibilities of increasing revenue by re-sorting our discarded Rags, focusing initially in four specific areas; Vintage/Retro, clearance items (to support a new shop), saleable items returned to standard shops and true Rag items. These results showed the potential of 16% of total rags being recovered, giving a large extra revenue opportunity.

The next challenge was to find a dual purpose site, large enough to support the resorting project and allowing expansion into other areas, with a shop attached to sell the clearance items thus avoiding further transport costs. In March 2013 the Resorting Centre was opened with a full time manager and two part time deputies, the Clearance shop opened at the start of April 2013. In order to monitor the outputs of the project, all items that are returned back to shops are tagged with a pre printed bar code for our Epos system to track. To fully understand this concept, all Shop Managers were invited to see the process first hand.

Additional revenue benefits to this project involve the team expanding into an upcycling section encompassing areas such as, bunting, felting, and removing unusual buttons, to sell in the shops. This will generate new volunteer opportunities in order to support this initiative.

We intend to further develop this initial project to resorting books in Sept 2013. This journey will continue to grow and adapt and creates a clear strong platform for further revenue developments, working on the concept of generating more income from our existing donations whilst reducing waste.

*Rags = donated clothes considered unsaleable
P77 Willen Hospice Winter Campaign - ‘A Wonderful Gift’
Authors: Green Helen
Published: October 2013

Background

Requirement identified to raise our profile in the local community, with new and existing supporter’s over the Winter (Christmas) period.

Holistic campaign designed to drive community responsibility, ownership and involvement.

Aims and objectives

Provide opportunity for supporters to engage– giving evidence of the value the Hospice provides to local community.

Re-engage with target audiences, driving them to take action.

Supporters feel that ‘care’ applies to supporters as well as patients.

Volunteers to feel integral and inspired.

Employees unite.

Generate income through retail streams, event attendance and donations.

Approach used

Engaging with Trustees, team members and creative resource a Campaign Brief was created, capturing key stakeholders, aims, and objectives. Communication vehicles and tactical elements were designed, timelines agreed and learning’s taken from our sector peers and retail competitors.

The ‘A Wonderful Gift’ proposition helps to demonstrate:

The specialist care provided by the Hospice is a gift to patients and families.

The cost of giving care is full of surprising facts, just like Christmas is full of surprises.

The gift (of support) makes wonderful things happen, gifts that mean something beyond the wrapping paper.

From here, tactical elements were designed:

An iconic branded blue gift box

Creative designs for Retail outlets

Cable Display Posters

Leaflets

Winter Draw Tickets

Twelve weeks of Christmas e-shots focusing on selected activity, i.e. e-shop gifts, Christmas cards, Memorial event, Lottery tickets, donating unwanted gifts, purchasing retail gifts, hosting fundraising events

Outcomes

Increased sales on Christmas Cards, e-shop gifts

Positive feedback on visual branding

Drove footfall into Shops/high street interest

Social Media posts - significant increase in ‘chatter’

Successful e-shots for Cards and Gifts - 31% unique opens and 5.17% click thru rate
The Bellamy challenge: it's about time
Authors: Dobson Geoffrey P , Letson H L , Tadaki D
Published: October 2013

In 1984, Col. Ronald Bellamy launched a worldwide challenge to develop a new resuscitation fluid to aid survival after catastrophic blood loss on the battlefield. In 1996, after careful compromise among need, cube weight and efficacy, the US military and later coalition forces adopted 6% hetastarch (HES) fluids for early resuscitation. In the intervening years, evidence has amassed indicating that the HES fluids may not be safe, and in June 2013 the US Food and Drug Administration issued a warning that HES solutions should not be used to treat patients with hypovolaemia or the critically ill. We review the unique challenges of early battlefield resuscitation, why the ‘Bellamy challenge’ remains open and discuss a number of forward-looking strategies that may help to solve the problem. The first two pillars of resuscitation that we believe have not been adequately addressed are rescuing and stabilising the heart (and brain) and the vascular system. The ‘ideal’ resuscitation fluid needs to nurture the heart and body slowly back to health, and not ‘shock’ it a second time with unnatural colloids or large volumes of unphysiological saline-based solutions.
TOTALLY GEODESIC SURFACES AND QUADRATIC FORMS
Authors: JAIPONG PRADTHANA
Published: October 2013

Let M be a compact, connected, irreducible, orientable 3-manifold with torus boundary. A closed, orientable, immersed, incompressible surface F in M with no incompressible annulus joining F and ∂M compresses in at most finitely many Dehn fillings M(α). It is known that there is no universal upper bound on the number of such fillings, independent of the surface, and the figure-eight knot complement is the first example of a manifold where this phenomenon occurs. In this paper, we show that the same behavior of the figure-eight knot complement is shared by other two cusped manifolds.
EFFICACY OF PRESSURE-BIOFEEDBACK GUIDED DEEP CERVICAL FLEXOR TRAINING ON NECK PAIN AND MUSCLE PERFORMANCE IN VISUAL DISPLAY TERMINAL OPERATORS
Authors: Nezamuddin Md. , Anwer Shahnawaz , Khan Sohrab Ahmad , Equebal Ameed
Published: October 2013

Purpose: This randomized trial study compared the efficacy of pressure-biofeedback guided deep cervical flexor training as an adjunct with conventional exercise on pain and muscle performance in visually displayed terminal operators. Methods: A total of 50 (22 men and 28 women) patients with neck pain participated in the study. Patients were randomly placed into two groups: a biofeedback group (n = 25) and a control group (n = 25). The biofeedback group received pressure-biofeedback guided deep cervical flexor training program for 5 days a week for 6 weeks, whereas the control group received an exercise program only. Results: On intergroup comparisons, the deep cervical flexor performance in biofeedback group, at the end of 6th week was significantly higher than those of control group (p < 0.01). Pain intensity was also significantly reduced in biofeedback group when compared to control group at the end of trial (p < 0.004). Conclusion: The addition of pressure-biofeedback to a 6-week conventional program appeared to increase deep cervical flexor muscle performance, compared to the exercise program alone for people with reduced muscle performance.
TIBIAL NERVE PERINEURAL INJECTIONS AT THE POSTERIOR TARSAL TUNNEL
Authors: Joseph Oliver C. , Uryasev Oleg , McNamara John P. , Dallas Apostolos P.
Published: October 2013

Introduction: Posterior tarsal tunnel syndrome (PostTTS) refers to compression of the tibial nerve (TN) within this tunnel. PostTTS is most commonly secondary to entrapment with subsequent inflammation. As it is true with other entrapment-type neuropathies, corticosteroids could provide therapeutic relief. To the authors' knowledge, the feasibility of such injections using ultrasound guidance has not been described in the literature. We hypothesize that one can inject the TN perineural space immediately proximal to the posterior tarsal tunnel utilizing ultrasonography US-guidance. Methods: This research was a pilot study using four cadaveric models. US was utilized to image the proximal posterior tarsal tunnel. Perineural injections of methylene blue were performed with subsequent dissection. Injections were designated as accurate (referring to nerve staining) and precise (referring to dye localization). Results: One cadaver was precluded due to pronounced musculoskeletal abnormality. 5-of-6 (83%) injections were accurate and 6-of-6 (100%) precise. Conclusion: Initial attempt was inaccurate and precise, while later injections were both accurate and precise. The most apparent source of error was from one cadaver's pronounced musculoskeletal deformity, which precluded successful injections bilaterally. Of the three cadavers unaffected by musculoskeletal deformity, accuracy was 5-of-6 (83%) and precision was 6-of-6 (100%). While surgery is the definitive treatment for refractory PostTTS, therapeutic effect of corticosteroid injections has not been evaluated in this patient population. Such injections could provide symptomatic relief and postpone surgical intervention. Small sample size not withstanding the results suggest that TN perineural injections are feasible under US-guidance. This study suggests that US-guidance can increase accuracy and precision and is a potential adjunct to the treatment. Future study will expand the initial data set and categorize consistent protocol. Subsequent translational research will then be sought to evaluate therapeutic efficacy in this patient population.
MISMATCH IN BODY–CHAIR DIMENSIONS AND THE ASSOCIATED MUSCULOSKELETAL PAIN AMONG SELECTED UNDERGRADUATE STUDENTS IN GHANA
Authors: Bello Ajediran I. , Sepenu Abigail S.
Published: October 2013

Purpose: To assess the misfit in body–chair dimensions with regard to the occurrence of musculoskeletal pain among undergraduates. Methods: Selected undergraduate students of School of Allied Health Sciences University of Ghana, participated in this study. The popliteal height, buttock-popliteal length and the hip breadth of the students were measured in sitting using retractable tape measure. The corresponding seat height, seat depth and seat width of three fixed-style lecture hall chairs were similarly measured and the average scores were determined. Mismatch or fit in body–chair dimension were calculated through a standard rule. The associated musculoskeletal pain as reported by the participants was assessed using numerical rating scale. Data were analyzed with percentage, mean, standard deviation and Krukas–Wallis test at p < 0.05. Results: A total of 126 students with mean age 22 ± 01 years were recruited. The mean popliteal height, buttock-popliteal length and hip breadth of the students were 40.8(4.5), 46.8(4.6) and 35.3(3.3) cm, respectively while the corresponding average chair dimensions for seat height, seat depth and seat width were 52.0, 51.0 and 53.0 cm, respectively. Appreciable number of the students mismatched the lecture hall chair at the three levels of study. About 114 (90.5%) of the students attributed their pain to the study chairs in which 40 (31.7%) and 38 (30.2%) were in their fourth and second years of study, respectively. Lower back pain was the most prevalent (38.6%) among the sampled students. Conclusion: The large proportion of the incompatibility indicated that the school chairs were not designed based on anthropometric dimensions, thus giving insight into the source of the pain.
Reduced BDNF attenuates inflammation and angiogenesis to improve survival and cardiac function following myocardial infarction in mice
Authors: Halade Ganesh V. , Ma Yonggang , Ramirez Trevi A. , Zhang Jianhua , Dai Qiuxia , Hensler Julie G. , Lopez Elizabeth F. , Ghasemi Omid , Jin Yu-Fang , Lindsey Merry L.
Published: October 2013

Brain-derived neurotrophic factor (BDNF) increases in failing hearts, but BDNF roles in cardiac remodeling following myocardial infarction (MI) are unclear. Male BDNF+/+[wild-type (WT)] and BDNF+/−heterozygous (HET) mice at 6–9 mo of age were subjected to MI and evaluated at days 1, 3, 5, 7, or 28 post-MI. At day 28 post-MI, 76% of HET versus 40% of WT survived, whereas fractional shortening improved and neovascularization levels were reduced in the HET (all, P < 0.05). At day 1, post-MI, matrix metalloproteinase-9, and myeloperoxidase (MPO) increased in WT, but not in HET. Concomitantly, monocyte chemotactic protein-1 and -5 levels increased and vascular endothelial growth factor (VEGF)-A decreased in HET. Neutrophil infiltration peaked at days 1–3 in WT mice, and this increase was blunted in HET. To determine if MPO administration could rescue the HET phenotype, MPO was injected at 3 h post-MI. MPO restored VEGF-A levels without altering matrix metalloproteinase-9 or neutrophil content. In conclusion, reduced BDNF levels modulated the early inflammatory and neovascularization responses, leading to improved survival and reduced cardiac remodeling at day 28 post-MI. Thus reduced BDNF attenuates early inflammation following MI by modulating MPO and angiogenic response through VEGF-A.
Methemoglobin-induced signaling and chemokine responses in human alveolar epithelial cells
Authors: Mumby Sharon , Ramakrishnan Latha , Evans Timothy W. , Griffiths Mark J. D. , Quinlan Gregory J.
Published: October 2013

Diffuse alveolar hemorrhage is characterized by the presence of red blood cells and free hemoglobin in the alveoli and complicates a number of serious medical and surgical lung conditions including the pulmonary vasculitides and acute respiratory distress syndrome. In this study we investigated the hypothesis that exposure of human alveolar epithelial cells to hemoglobin and its breakdown products regulates chemokine release via iron- and oxidant-mediated activation of the transcription factor NF-κB. Methemoglobin alone stimulated the release of IL-8 and MCP-1 from A549 cells via activation of the NF-κB pathway; additionally, IL-8 required ERK activation and MCP-1 required JNK activation. Neither antioxidants nor iron chelators and knockdown of ferritin heavy and light chains affected these responses, indicating that iron and reactive oxygen species are not involved in the response of alveolar epithelial cells to methemoglobin. Incubation of primary cultures of human alveolar type 2 cells with methemoglobin resulted in a similar pattern of chemokine release and signaling pathway activation. In summary, we have shown for the first time that methemoglobin induced chemokine release from human lung epithelial cells independent of iron- and redox-mediated signaling involving the activation of the NF-κB and MAPK pathways. Decompartmentalization of hemoglobin may be a significant proinflammatory stimulus in a variety of lung diseases.
Disruption of N-linked glycosylation promotes proteasomal degradation of the human ATP-binding cassette transporter ABCA3
Authors: Beers Michael F. , Zhao Ming , Tomer Yaniv , Russo Scott J. , Zhang Peggy , Gonzales Linda W. , Guttentag Susan H. , Mulugeta Surafel
Published: October 2013

The lipid transport protein, ABCA3, expressed in alveolar type 2 (AT2) cells, is critical for surfactant homeostasis. The first luminal loop of ABCA3 contains three putative N-linked glycosylation sites at residues 53, 124, and 140. A common cotranslational modification, N-linked glycosylation, is critical for the proper expression of glycoproteins by enhancing folding, trafficking, and stability through augmentation of the endoplasmic reticulum (ER) folding cycle. To understand its role in ABCA3 biosynthesis, we utilized EGFP-tagged fusion constructs with either wild-type or mutant ABCA3 cDNAs that contained glutamine for asparagine substitutions at the putative glycosylation motifs. In A549 cells, inhibition of glycosylation by tunicamycin increased the electrophoretic mobility (Mr) and reduced the expression level of wild-type ABCA3 in a dose-dependent manner. Fluorescence imaging of transiently transfected A549 or primary human AT2 cells showed that although single motif mutants exhibited a vesicular distribution pattern similar to wild-type ABCA3, mutation of N124 and N140 residues resulted in a shift toward an ER-predominant distribution. By immunoblotting, the N53 mutation exhibited no effect on either the Mror ABCA3 expression level. In contrast, substitutions at N124 or N140, as well a N124/N140 double mutation, resulted in increased electrophoretic mobility indicative of a glycosylation deficiency accompanied by reduced overall expression levels. Diminished steady-state levels of glycan-deficient ABCA3 isoforms were rescued by treatment with the proteasome inhibitor MG132. These results suggest that cotranslational N-linked glycosylation at N124 and N140 is critical for ABCA3 stability, and its disruption results in protein destabilization and proteasomal degradation.
TACE in perinatal mouse lung epithelial cells promotes lung saccular formation
Authors: Xu Wei , Liu Chengyu , Kaartinen Vesa , Chen Hui , Lu Chi-Han , Zhang Wenming , Luo Yongfeng , Shi Wei
Published: October 2013

Tumor necrosis factor-α converting enzyme (TACE) is a cell membrane sheddase, expressed in both developmental lung epithelia and mesenchyme. Global abrogation of TACE results in neonatal lethality and multiple organ developmental abnormalities, including dysplastic lung. To further define the roles of TACE in regulating lung development, lung epithelial and/or mesenchymal specific TACE conditional knockout mice were generated. Blockade of TACE function in developing lung epithelial cells caused reduced saccular formation, decreased cell proliferation, and reduced mid-distal lung epithelial cell differentiation. In contrast, mesenchymal TACE knockout did not have any phenotypic change in developing lung. Simultaneous abrogation of TACE in both lung epithelial and mesenchymal cells did not result in a more severe lung abnormality. Interestingly, these lung-specific TACE conditional knockout mice were not neonatal lethal, and their lung structures were essentially normal after alveolarization. In addition, TACE conditional knockout in developing cardiomyocytes resulted in noncompaction of ventricular myocardium, as seen in TACE conventional knockout mice. However, these mice were also not neonatal lethal. In conclusion, lung epithelial TACE is essential for promoting fetal lung saccular formation, but not postnatal lung alveolarization in mice. Because the developmental abnormality of either lung or heart induced by TACE deficiency does not directly lead to neonatal lethality, the neonatal death of TACE conventional knockout mice is likely a result of synergistic effects of multiple organ abnormalities.
The Witschi Hypothesis revisited after 35 years: genetic proof from SP-C BRICHOS domain mutations
Authors: Uhal Bruce D. , Nguyen Hang
Published: October 2013

Over 35 years ago, Wanda Haschek and Hanspeter Witschi published a theory for the pathogenesis of lung fibrosis that dared to challenge the longstanding view of lung fibrosis as an “inflammatory disease.” On the basis of considerable experimental evidence, they proposed that lung fibrosis was initiated and propagated by microfoci of epithelial damage that, if unrepaired, upset the normal epithelial-fibroblast balance to create profibrotic microenvironments, without any obligatory contribution of “inflammatory” cells. Unfortunately, this theory was largely overlooked for many years. In the meantime, the repeated failure of attempts to treat idiopathic pulmonary fibrosis with anti-inflammatory regimens has led some investigators to revive the theory referred to, in decades past, as “The Witschi Hypothesis.” This manuscript briefly reviews more recent evidence in support of the “Severity of Epithelial Injury” Hypothesis proposed by Haschek and Witschi. More important, it offers the updated viewpoint that mutations in the BRICHOS domain of surfactant protein C, which cause interstitial lung disease and induce cell death specifically in lung epithelial cells, in effect provide genetic proof that the Witschi Hypothesis is indeed the correct theory to explain the pathogenesis of fibrosis in the lungs.
Airway smooth muscle in airway reactivity and remodeling: what have we learned?
Authors: Prakash Y. S.
Published: October 2013

It is now established that airway smooth muscle (ASM) has roles in determining airway structure and function, well beyond that as the major contractile element. Indeed, changes in ASM function are central to the manifestation of allergic, inflammatory, and fibrotic airway diseases in both children and adults, as well as to airway responses to local and environmental exposures. Emerging evidence points to novel signaling mechanisms within ASM cells of different species that serve to control diverse features, including 1) [Ca2+]icontractility and relaxation, 2) cell proliferation and apoptosis, 3) production and modulation of extracellular components, and 4) release of pro- vs. anti-inflammatory mediators and factors that regulate immunity as well as the function of other airway cell types, such as epithelium, fibroblasts, and nerves. These diverse effects of ASM “activity” result in modulation of bronchoconstriction vs. bronchodilation relevant to airway hyperresponsiveness, airway thickening, and fibrosis that influence compliance. This perspective highlights recent discoveries that reveal the central role of ASM in this regard and helps set the stage for future research toward understanding the pathways regulating ASM and, in turn, the influence of ASM on airway structure and function. Such exploration is key to development of novel therapeutic strategies that influence the pathophysiology of diseases such as asthma, chronic obstructive pulmonary disease, and pulmonary fibrosis.
The “Hidden Diversity” of Medicinal Plants in Northeastern Brazil: Diagnosis and Prospects for Conservation and Biological Prospecting
Authors: Cavalcanti Deyvson Rodrigues , Albuquerque Ulysses Paulino
Published: October 2013

Increases in ethnobotanical studies and knowledge in recent decades have led to a greater and more accurate interpretation of the overall patterns related to the use of medicinal plants, allowing for a clear identification of some ecological and cultural phenomena. “Hidden diversity” of medicinal plants refers in the present study to the existence of several species of medicinal plants known by the same vernacular name in a given region. Although this phenomenon has previously been observed in a localized and sporadic manner, its full dimensions have not yet been established. In the present study, we sought to assess the hidden diversity of medicinal plants in northeastern Brazil based on the ethnospecies catalogued by local studies. The results indicate that there are an average of at least 2.78 different species per cataloged ethnospecies in the region. Phylogenetic proximity and its attendant morphological similarity favor the interchangeable use of these species, resulting in serious ecological and sanitary implications as well as a wide range of options for conservation and bioprospecting.
Mixed Convection Boundary Layer Flow Embedded in a Thermally Stratified Porous Medium Saturated by a Nanofluid
Authors: Mat Yasin Mohd Hafizi , Arifin Norihan Md. , Nazar Roslinda , Ismail Fudziah , Pop Ioan
Published: October 2013

We present the numerical investigation of the steady mixed convection boundary layer flow over a vertical surface embedded in a thermally stratified porous medium saturated by a nanofluid. The governing partial differential equations are reduced to the ordinary differential equations, using the similarity transformations. The similarity equations are solved numerically for three types of metallic or nonmetallic nanoparticles, namely, copper (Cu), alumina (Al2O3), and titania (TiO2), in a water-based fluid to investigate the effect of the solid volume fraction or nanoparticle volume fraction parameter φ of the nanofluid on the flow and heat transfer characteristics. The skin friction coefficient and the velocity and temperature profiles are presented and discussed.
Fracture Formation Evaluation of Reinforced Concrete Structure Using Acoustic Emission Technique
Authors: Panjsetooni Alireza , Bunnori Norazura Muhamad , Vakili Amir Hossein , Shirkhani Zohreh , Shirkhani Zeinab
Published: October 2013

Acoustic emission (AE) is an important nondestructive evaluation (NDE) technique used in the field of structural engineering for both case local and global monitoring. In this study AE technique with a new approach was employed to investigate the process of fracture formation in reinforced concrete structure. A number of reinforced concrete (RC) one story frames were tested under loading cycle and were simultaneously monitored using AE. The AE test data was analyzed using the relaxation ratio and calm and load ratio method. Also, the relaxation ratio was dominated with approaching load to 58% of the ultimate load. In addition three levels of damage using calm and load ratio were distinguished. The trend of relaxation ratio and calm and load ratio method during loading and unloading showed that these methods are strongly sensitive with cracks growth in RC frame specimens and were able to indicate the levels of damage. Also, results showed that AE can be considered as a viable method to predict the remaining service life of reinforced concrete. In addition, with respect to the results obtained from relaxation ratio and, load and calm ratio indicated, a new chart is proposed.