Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
5,467
result(s) for
"Hall, Daniel"
Sort by:
Informed consent for clinical treatment
Although informed consent for clinical treatment has become a vital part of contemporary medical practice, it means different things in different contexts, is variably practised and rarely achieves the theoretical ideal. In this review, we focus on the clinical practice of informed consent. We first describe what we know about informed consent: what it is, where it came from and what purposes it serves. We then describe several limitations that complicate the practice of informed consent. Finally, we make several practical suggestions as to how clinicians might optimally approach the informed consent process. 79 references
Journal Article
COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak
Background
The COVID-19 pandemic brings unprecedented uncertainty and stress. This study aimed to characterize general sleep status among Chinese residents during the early stage of the outbreak and to explore the network relationship among COVID-19 uncertainty, intolerance of uncertainty, perceived stress, and sleep status.
Methods
A cross-sectional correlational survey was conducted online. A total of 2534 Chinese residents were surveyed from 30 provinces, municipalities, autonomous regions of China and regions abroad during the period from February 7 to 14, 2020, the third week of lockdown. Final valid data from 2215 participants were analyzed. Self-report measures assessed uncertainty about COVID-19, intolerance of uncertainty, perceived stress, and general sleep status. Serial mediation analysis using the bootstrapping method and path analysis were applied to test the mediation role of intolerance of uncertainty and perceived stress in the relationship between uncertainty about COVID-19 and sleep status.
Results
The total score of sleep status was 4.82 (SD = 2.72). Age, place of residence, ethnicity, marital status, infection, and quarantine status were all significantly associated with general sleep status. Approximately half of participants (47.1%) reported going to bed after 12:00 am, 23.0% took 30 min or longer to fall asleep, and 30.3% slept a total of 7 h or less. Higher uncertainty about COVID-19 was significantly positively correlated with higher intolerance of uncertainty (r = 0.506,
p
< 0.001). The mediation analysis found a mediating role of perceived stress in the relationship between COVID-19 uncertainty and general sleep status (
β =
0.015, 95%C.I. = 0.009–0.021). However, IU was not a significant mediator of the relationship between COVID-19 uncertainty and sleep (
β =
0.009, 95%C.I. = − 0.002–0.020). Moreover, results from the path analysis further showed uncertainty about COVID-19 had a weak direct effect on poor sleep (β = 0.043,
p
< 0.05); however, there was a robust indirect effect on poor sleep through intolerance of uncertainty and perceived stress.
Conclusions
These findings suggest that intolerance of uncertainty and perceived stress are critical factors in the relationship between COVID-19 uncertainty and sleep outcomes. Results are discussed in the context of the COVID-19 pandemic, and practical policy implications are also provided.
Journal Article
Using look-ahead plans to improve material flow processes on construction projects when using BIM and RFID technologies
Purpose
Building information modelling (BIM) and radio frequency identification (RFID) technologies have been extensively explored to improve supply chain visibility and coordination of material flow processes, particularly in the pursuit of Industry 4.0. It remains challenging, however, to effectively use these technologies to enable the precise and reliable coordination of material flow processes. This paper aims to propose a new workflow designed to include the use of detailed look-ahead plans when using BIM and RFID technologies, which can accurately track and match both the dynamic site needs and supply status of materials.
Design/methodology/approach
The new workflow is designed according to lean theory and is modeled using business process modeling notation. To digitally support the workflow, an integrated BIM-RFID database system is constructed that links information on material demands with look-ahead plans. The new workflow is then used to manage material flows in the erection of an office building with prefabricated columns. The performance of the new workflow is compared with that of a traditional workflow, using discrete event simulations. The input for the simulations was derived from expert opinion in semi-structured interviews.
Findings
The new workflow enables contractors to better observe on-site status and differences between the actual and planned material requirements, as well as to alert suppliers if necessary. The simulation results indicate that the new workflow has the potential to reduce the duration of the material flow processes by 16.1% compared with the traditional workflow.
Research limitations/implications
The new workflow is illustrated using a real-world-like situation with input data based on expert opinion. Although the workflow shows potential, it should be tested on a real-world site.
Practical implications
The new workflow allows project participants to combine detailed near-term look-ahead plans with BIM and RFID technologies to better manage material flow processes. It is particularly useful for the management of engineer-to-order components considering the dynamic site progress.
Originality/value
The research improves on existing research focused on using BIM and RFID technologies to improve material flow processes by showing how the workflow can be adapted to use detailed look-ahead plans. It reinforces data-driven construction material management practices through improved visibility and reliability in planning and control of material flow processes.
Journal Article
Conductive organic electrodes for flexible electronic devices
The paper reports on a novel process flow to manufacture conductive organic electrodes from highly conductive doped PEDOT:PSS polymer films that can be patterned and display a good adhesion to oxidized Si wafers as well as to flexible substrates, such as Mylar. Among other results, it is shown that multiple depositions of PEDOT:PSS increase the electrical conductivity by more than two orders of magnitude without increasing the film thickness of PEDOT:PSS significantly. An exponential dependence between sheet resistance and the number of PEDOT:PSS coatings has been found. The electrical conductivity of PEDOT:PSS can be increased by another two orders of magnitude doping with Cu nanoparticles when coated on the surface of a soft-baked PEDOT:PSS film. It is found, however, that both kinds of conductivity enhancement are not additive. Adhesion of PEDOT:PSS to oxidized Si wafers and BoPET (Mylar) has been ensured by applying an oxygen plasma cleaning step before spin coating. The manufactured high-conductivity PEDOT:PSS film can be patterned using a sacrificial metal layer with subsequent etching of PEDOT:PSS in oxygen plasma, followed by the removal of the patterned segments of the sacrificial metal layer in an aqueous acid solution.
Journal Article
Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis
Purpose
To evaluate the independent effect of frailty, as measured by the Risk Analysis Index-Administrative (RAI-A) for postoperative complications and discharge outcomes following brain tumor resection (BTR) in a large multi-center analysis.
Methods
Patients undergoing BTR were queried from the National Surgical Quality Improvement Program (NSIQP) for the years 2015 to 2019. Multivariable logistic regression was performed to evaluate the independent associations between frailty tools (age, 5-factor modified frailty score [mFI-5], and RAI-A) on postoperative complications and discharge outcomes.
Results
We identified 30,951 patients who underwent craniotomy for BTR; the median age of our study sample was 59 (IQR 47–68) years old and 47.8% of patients were male. Overall, increasing RAI-A score, in an overall stepwise fashion, was associated with increasing risk of adverse outcomes including in-hospital mortality, non-routine discharge, major complications, Clavien-Dindo Grade IV complication, and extended length of stay. Multivariable regression analysis (adjusting for age, sex, BMI, non-elective surgery status, race, and ethnicity) demonstrated that RAI-A was an independent predictor for worse BTR outcomes. The RAI-A tiers 41–45 (1.2% cohort) and > 45 (0.3% cohort) were ~ 4 (Odds Ratio [OR]: 4.3, 95% CI: 2.1–8.9) and ~ 9 (OR: 9.5, 95% CI: 3.9–22.9) times more likely to have in-hospital mortality compared to RAI-A 0–20 (34% cohort).
Conclusions and Relevance
Increasing preoperative frailty as measured by the RAI-A score is independently associated with increased risk of complications and adverse discharge outcomes after BTR. The RAI-A may help providers present better preoperative risk assessment for patients and families weighing the risks and benefits of potential BTR.
Journal Article
Relationship between adverse childhood experiences and anxiety symptoms among Chinese adolescents: The role of self-compassion and social support
Previous studies have revealed that adverse childhood experiences (ACEs) create a significant and lasting effect of increased anxiety. However, few studies have examined the mediating and moderating mechanisms underlying this relation. The present study aimed to explore the mediating role of self-compassion and moderating role of social support in ACEs-anxiety relationship among Chinese adolescents. In this cross-sectional study, 1,764 middle school students completed questionnaires measuring their levels of ACEs, anxiety, self-compassion (SC), and social support. Correlations of variables were computed using Pearson’s r. Mediation and moderated mediation models were tested using PROCESS macro with the regression bootstrapping method. After covariates (age and gender) were controlled, results showed that: (1) ACEs were positively associated with anxiety symptoms; (2) self-compassion partially mediated the ACEs-anxiety association; (3) both ACEs-anxiety and SC-anxiety relationships were moderated by social support. Specifically, social support was associated with lower anxiety, particularly among students with fewer ACEs or lower level of self-compassion. Reducing possible adversities existing in environment may help to reduce risk of anxiety for adolescents. Cultivating self-compassion is crucial for adolescents’ mental health, since it may play a role in ACEs-anxiety relationship. Social support would operate as a buffer to ACEs in the relation with anxiety, under the circumstances of mild adversities, and a promoter to self-compassion in the relation with anxiety, under the circumstances of low self-compassion.
Journal Article
We Can Do Better: Why Pastoral Care Visitation to Hospitals is Essential, Especially in Times of Crisis
From his perspective as a general surgeon, Episcopal priest and Medical Director for High Risk Populations and Outcomes at a large health-care system, the author identifies an unrecognized problem that clergy were banned from visiting parishioners in most hospitals across the country during the height of the Covid-19 pandemic—a situation that persists in many contexts. The author explains why pastoral visitation should be considered essential care—especially at a time of crisis—and encourages hospital administrators across the country to clarify policies to welcome community clergy as essential personnel, but to do so with prudent procedures that mitigate risk to the community and to the visiting clergy. Given the fact that most hospitals in this country were founded by religious organizations and still carry the imprint of that founding in their names, it would be tragic for these very same hospitals to cut patients off from their religious communities precisely at the time they need them most.
Journal Article
Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients
Abstract
BACKGROUND
With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events.
OBJECTIVE
To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease.
METHODS
As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data.
RESULTS
From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions.
CONCLUSION
Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.
Graphical Abstract
Graphical Abstract
Journal Article