Why has the safety and quality movement been slow to improve care?

Buist and Middleton lament that the safety and quality 'agenda' has failed to fundamentally alter the safety of healthcare systems, in part because of the disengagement of doctors from their responsibilities for patient safety . While there have been discernable improvements in the efficiency and effectiveness of care in some settings, patients still experience unacceptable harm and often struggle to have their voices heard; processes are not as efficient as they could be; and costs continue to rise at alarming rates while quality issues remain . Perhaps of most concern, recent public reports into health system failures continue to document a widespread lack of attentiveness to patient concerns, a culture of denial and widespread lack of professionalism . Alarmingly, clinician discontentment, cynicism and burn-out are reflected in antagonistic language by clinicians about the healthcare system and their patients. Taken together with the many dissatisfied and now more vocal patient groups, all point to an unprecedented crisis of faith in our healthcare systems which has been getting worse over past decade . This personal perspective aims to address the fundamental tensions that are keeping much of healthcare reform efforts from successfully transforming the culture and outcomes except at the margins.

Paradox lost: variable colour-pattern geometry is associated with differences in movement in aposematic frogs

Aposematic signal variation is a paradox: predators are better at learning and retaining the association between conspicuousness and unprofitability when signal variation is low. Movement patterns and variable colour patterns are linked in non-aposematic species: striped patterns generate illusions of altered speed and direction when moving linearly, affecting predators' tracking ability; blotched patterns benefit instead from unpredictable pauses and random movement. We tested whether the extensive colour-pattern variation in an aposematic frog is linked to movement, and found that individuals moving directionally and faster have more elongated patterns than individuals moving randomly and slowly. This may help explain the paradox of polymorphic aposematism: variable warning signals may reduce protection, but predator defence might still be effective if specific behaviours are tuned to specific signals. The interacting effects of behavioural and morphological traits may be a key to the evolution of warning signals. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Functional range of movement of the hand : declination angles to reachable space

 The measurement of the range of hand joint movement is an essential part of clinical practice and rehabilitation. Current methods use three finger joint declination angles of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. In this paper we propose an alternate form of measurement for the finger movement. Using the notion of reachable space instead of declination angles has significant advantages. Firstly, it provides a visual and quantifiable method that therapists, insurance companies and patients can easily use to understand the functional capabilities of the hand. Secondly, it eliminates the redundant declination angle constraints. Finally, reachable space, defined by a set of reachable fingertip positions, can be measured and constructed by using a modern camera such as Creative Senz3D or built-in hand gesture sensors such as the Leap Motion Controller. Use of cameras or optical-type sensors for this purpose have considerable benefits such as eliminating and minimal involvement of therapist errors, non-contact measurement in addition to valuable time saving for the clinician. A comparison between using declination angles and reachable space were made based on Hume's experiment on functional range of movement to prove the efficiency of this new approach.

Detection of respiratory paradoxical movement via doppler radar measurements

 This paper presents an evaluation of microwave Doppler radar in capturing the respiration signal from the chest and abdomen simultaneously using two radar systems. Two experiments were conducted to investigate the feasibility of using Doppler radar in measuring respiration from both chest and abdomen simultaneously. Results obtained indicate that the respiration patterns from the radar were highly correlated with the reference respiration strap readings for normal breathing scenarios and also sensitive enough in capturing the paradoxical movement between the chest and the abdomen in the professionally role played experiments.

Leaders benefit followers in the collective movement of a social sawfly

The challenges of maintaining cohesion while making collective decisions in social or aggregating insects can result in the emergence of a leader or leaders. Larval aggregations of the steel-blue sawfly Perga affinis forage nocturnally, and some larvae lead the aggregation on foraging trips more often than expected by chance. We investigated the relationship between these leader and follower roles by comparing the weight and growth of individual larvae with different roles. Our observations reveal no significant difference between the growth of leaders and followers, suggesting that the role of leadership may not provide direct foraging benefits. However, by experimentally manipulating the social structure of larval aggregations, we found that individuals within aggregations that comprise a mixture of leaders and followers enjoy higher growth rates than those in aggregations comprising a single behavioural type. These data demonstrate, for the first time, individual benefits to maintaining a balance of leader and follower roles within larval aggregations, and highlight the importance of considering the perspectives of both leaders and followers when investigating the evolutionary significance of this behavioural variation within animal groups.

Simulated hyperopic anisometropia and reading, visual information processing, and reading-related eye movement performance in children.

Purpose: This study investigated the impact of simulated hyperopic anisometropia and sustained near work on performance of academic-related measures in children.
Methods: Participants included 16 children (mean age: 11.1 ± 0.8 years) with minimal refractive error. Academic-related outcome measures included a reading test (Neale Analysis of Reading Ability), visual information–processing tests (Coding and Symbol Search subtests from the Wechsler Intelligence Scale for Children), and a reading-related eye movement test (Developmental Eye Movement test). Performance was assessed with and without 0.75 diopters of simulated monocular hyperopic defocus (administered in a randomized order), before and after 20 minutes of sustained near work. Unilateral hyperopic defocus was systematically assigned to either the dominant or nondominant sighting eye to evaluate the impact of ocular dominance on any performance decrements.
Results: Simulated hyperopic anisometropia and sustained near work both independently reduced performance on all of the outcome measures (P < 0.001). A significant interaction was also observed between simulated anisometropia and near work (P < 0.05), with the greatest decrement in performance observed during simulated anisometropia in combination with sustained near work. Laterality of the refractive error simulation (ocular dominance) did not significantly influence the outcome measures (P > 0.05). A reduction of up to 12% in performance was observed across the range of academic-related measures following sustained near work undertaken during the anisometropic simulation.
Conclusions: Simulated hyperopic anisometropia significantly impaired academic-related performance, particularly in combination with sustained near work. The impact of uncorrected habitual anisometropia on academic-related performance in children requires further investigation. © 2014 The Association for Research in Vision and Ophthalmology, Inc.

Mapping potential risk for housing damage from ground movement due to climate change

The performance of footings in residential construction is influenced by the degree of ground movement, particularly in reactive soils, which is driven by the magnitude of change in soil moisture. New patterns of climate are affecting residential foundations and causing serious and expensive damage. This paper produces a map of potential risk for housing damage from ground movement due to climate change. Using a geographic information system, it combines information on (1) soil moisture change related to climate, using TMI as the indicator, and (2) population growth. Preliminary results, having Victoria, Australia, in the last decade as the case study, suggest that effects of climate change on soil, and resulting impacts on house foundations, are not being taken into consideration in current planning strategies for urban development. Most of the urban growth priority zones in the study area are susceptible to medium and high risk for damage. Producing new and renovated buildings that are durable in the long term is essential for the economy, environment and social welfare. The map presented here can assist policies and strategies towards urban resilience in the context of climate change.

Teaching a digital performing agent: artificial neural network and hidden Markov Model for recognising and performing dance movement

For a Digital Performing Agent to be able to perform live with a human dancer, it would be useful for the agent to be able to contextualize the movement the dancer is performing and to have a suitable movement vocabulary with which to contribute to the performance. In this paper we will discuss our research into the use of Artificial Neural Networks (ANN) as a means of allowing a software agent to learn a shared vocabulary of movement from a dancer. The agent is able to use the learnt movements to form an internal representation of what the dancer is performing, allowing it to follow the dancer, generate movement sequences based on the dancer's current movement and dance independently of the dancer using a shared movement vocabulary. By combining the ANN with a Hidden Markov Model (HMM) the agent is able to recognize short full body movement phrases and respond when the dancer performs these phrases. We consider the relationship between the dancer and agent as a means of supporting the agent's learning and performance, rather than developing the agent's capability in a self-contained fashion.

Prevalence and stability of active play, restricted movement and television viewing in infants

This study describes engagement in and stability of physical activity and sedentary behaviours in early life, and assesses associations with sex, maternal education and developmental stage. Maternal-report data at child age 4, 9 and 20 months were collected from 542 families in the Melbourne Infant Feeding Activity and Nutrition Trial Program. Parents estimated average time per day their child spent in active pursuits or pursuits that restricted movement. With increasing age, children generally spent more time in active pursuits and watching television, and less time in situations that restrict movement. Associations were found with age of developmental milestone attainment but not sex or maternal education. Stability over time was strongest for television viewing (β = 0.34–0.38) and time spent outdoors (β = 0.27–0.33). Contrary to guidelines, television viewing increased and showed stability, suggesting a need to target this behaviour very early in life to achieve optimal longer term outcomes.

Post-exercise depression in corticomotor excitability after dynamic movement: a general property of fatiguing and non-fatiguing exercise

Transcranial magnetic stimulation has been used to study changes in central excitability associated with motor tasks. Recently, we reported that a finger flexion–extension task performed at a maximal voluntary rate (MVR) could not be sustained and that this was not due to muscle fatigue, but was more likely a breakdown in central motor control. To determine the central changes that accompany this type of movement task, we tracked motor-evoked potential (MEP) amplitude from the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles of the dominant hand in normal subjects for 20 min after a 10 sec index finger flexion–extension task performed at MVR and at a moderate sustainable rate (MSR) and half the MSR (MSR/2). The FDI MEP amplitude was reduced for up to 6–8 min after each of the tasks but there was a greater and longer-lasting reduction after the MSR and MSR/2 tasks compared to the MVR task. There was a similar reduction in the amplitude of the FDI MEP after a 10 sec cyclic index finger abduction–adduction task when the FDI was acting as the prime mover. The amplitude of the MEP recorded from the inactive APB was also reduced after the flexion–extension tasks, but to a lesser degree and for a shorter duration. Measurements of short-interval cortical inhibition revealed an increase in inhibition after all of the finger flexion–extension tasks, with the MSR task being associated with the greatest degree of inhibition. These findings indicate that a demanding MVR finger movement task is followed by a period of reduced corticomotor excitability and increased intracortical inhibition. However, these changes also occur with and are greater with slower rates of movement and are not specific for motor demand, but may be indicative of adaptive changes in the central motor pathway after a period of repetitive movement.

Associations between skill perceptions and young children's actual fundamental movement skills

-Given that children with low movement skill competence engage in less physical activity, it is important to understand how children's perceptions relate to actual movement competence. This study examined relationships between (i) children's self-perception and objective assessments of their movement skills (object control and locomotor) and (ii) parents' perceptions of the children's movement skills and objective assessment. Children's skill perceptions were assessed using the Pictorial Scale of Perceived Movement Skill Competence for Young Children. Parent perceptions of their child's skills were assessed using a modified version of this instrument. The Test of Gross Motor Development-2nd edition assessed children's skills objectively. Participants were 136 Australian children (51% boys; M = 6.5 yr., SD = 1.1) and 133 parents. Regression analyses (by sex) examined the relationship between perceptions and children's scores for actual skilled performance. Boys' perceptions were associated with their actual object control ability. Parents accurately perceived boys' object control ability and girls' locomotor ability, but not the reverse. This suggests interventions aiming to improve children's movement skills could target parents and be designed to teach parents how to recognize good and poor skill performance in their children.

Movement ecology of nomadic arid zone waterfowl

This thesis provides insights into the spatial and temporal patterns of movement in nomadic waterfowl, the response of birds to rapid environmental change, behavioural flexibility of avian movements and the ability of birds to locate seemingly unpredictable water bodies in vast arid landscapes.

The Nazis’ use of ‘Sieg Heil’: a point of continuity with the Völkisch movement

This historical note briefly considers the history of the phrase ‘Sieg Heil,’ using excerpts from original sources. It argues that this phrase, and the swastika, marked points of continuity with the earlier völkisch movement.