Placement Assistance Research Articles

Preprocedural Ultrasound Assessment Does Not Improve Trainee Performance of Spinal Anesthesia for Obstetrical Patients: A Randomized Controlled Trial

(J Clin Anesth. 2017;37:21–24) Although spinal ultrasound can assist with identification of axial anatomical structures and intervertebral spaces, there are ergonomic challenges with needle angulation and depth. In fact, some studies with residents have suggested that there is no benefit to using ultrasound assistance for epidural placement. However, these studies were limited by small size or specificity to center. In the present study, the authors evaluated the impact of additional information provided by preprocedural ultrasound examination among trainee anesthesiologists performing spinal anesthesia in obstetric patients undergoing elective cesarean delivery in a blinded, randomized controlled trial.

A Rural "Grow Your Own" Strategy: Building Providers From the Local Workforce.

Rural health care leaders are increasingly tasked with the responsibility of providing health access to 21% of the national population with only 10% of the provider workforce. Provider recruitment strategies offering loan repayment have had some success in the short term but are less impactful at creating a long-term retention rate, unless the providers have an existing connection to either the community in which they are working or rural health care. Responding to these data, a demonstration project and study has been underway in Colorado to test a rural focused "grow your own" advanced practice registered nurse (APRN) model. Phase 1 is designed to measure recruitment of RNs from inside rural communities to return to school and become primary care providers within those communities. Phase 2 will measure completion of education and phase 3 will measure retention rates in those communities. This article reports on phase 1 of the project, which is recruitment. The project offers stipend support with assistance in the school application process, educational support, clinical and job placement assistance, and monthly coaching. In addition, communities were asked to provide matching funds to support the APRN students with a goal of creating a self-sustaining model that will build a continuous pipeline of APRN providers. This strategy avoids the costly need to recruit and relocate providers who have no ties to the community. Thirty-four of 36 nurses (94%) responded to the study survey. Survey results suggested that the combination of financial, community, and employer support utilized in this model could serve to create a new and sustainable strategy for building a rural APRN provider workforce pipeline. The ultimate outcome has the potential to ensure that all people in rural areas have access to a high-quality, well-educated primary care provider.

Steinmann Pins for C1 Lateral Mass Screw Placement During Atlantoaxial Stabilization.

The authors describe a modified technique for placement of the C1 lateral mass screw using a Steinmann pin as a guide. This technique minimizes dissection and provides atlantoaxial stabilization during arthrodesis. In our technique, a nonthreaded 1.6-mm spade-tip Steinmann pin is placed into the lateral mass of C1 to serve as a guide over which a powered drill is used for screw insertion. Perioperative data were collected for consecutive patients who underwent a C1-2 arthrodesis that involved the modified technique between March 2010 and July 2016. Data included blood loss, operative times, and C2 nerve root injury. The data for 93 patients were reviewed. Most (91.4%) patients presented with a fracture from an acute trauma. A mean of 1.97 levels was fused in these patients, with a mean blood loss of 76 mL and a mean operative time of 144 minutes. The overall morbidity and mortality rate was 10.7%. The morbidity rate of 7.5% included 30-day postoperative complications of respiratory failure and dysphasia. There were no postoperative vertebral artery injuries, hardware failures, or instances of occipital neuralgia. The use of Steinmann pins to guide the placement of C1 lateral mass screws is safe and effective in C1-2 arthrodesis. Limiting dissection minimizes blood loss and injury, maintains efficient operative time, and assists in accurate placement of the screws. Furthermore, with less manipulation and retraction of the C2 nerve root, postoperative occipital neuralgia and the need for C2 root transection are avoided.

Project Career: An individualized postsecondary approach to promoting independence, functioning, and employment success among students with traumatic brain injuries.

Project Career is a five-year interdisciplinary demonstration project funded by NIDILRR. It provides technology-driven supports, merging Cognitive Support Technology (CST) evidence-based practices and rehabilitation counseling, to improve postsecondary and employment outcomes for veteran and civilian undergraduate students with traumatic brain injury (TBI). Provide a technology-driven individualized support program to improve career and employment outcomes for students with TBI. Project staff provide assessments of students' needs relative to assistive technology, academic achievement, and career preparation; provide CST training to 150 students; match students with mentors; provide vocational case management; deliver job development and placement assistance; and maintain an electronic portal regarding accommodation and career resources. Participating students receive cognitive support technology training, academic enrichment, and career preparatory assistance from trained professionals at three implementation sites. Staff address cognitive challenges using the 'Matching Person with Technology' assessment to accommodate CST use (iPad and selected applications (apps)). JBS International (JBS) provides the project's evaluation. To date, 117 students participate with 63% report improved life quality and 75% report improved academic performance. Project Career provides a national model based on best practices for enabling postsecondary students with TBI to attain academic, employment, and career goals.

Imaging and Peritoneal Dialysis Catheters.

The placement of a peritoneal dialysis (PD) catheter by interventionalists demands not only procedural skill but also an ability to decipher real-time ultrasonographic and fluoroscopic images. In this article, we discuss how imaging assists in PD placement and recognition of complications. To aid this endeavor, we have provided images and video clips that should assist interventionalists. Compared with the fluoroscopic technique, peritoneoscopic PD catheter placement provides direct visual imaging to also aid placement of the initial trocar and the peritoneal catheter.

Designing a camera placement assistance system for human motion capture based on a guided genetic algorithm

In multi-camera motion capture systems, determining the optimal camera configuration (camera positions and orientations) is still an unresolved problem. At present, configurations are primarily guided by a human operator’s intuition, which requires expertise and experience, especially with complex, cluttered scenes. In this paper, we propose a solution to automate camera placement for motion capture applications in order to assist a human operator. Our solution is based on the use of a guided genetic algorithm to optimize camera network placement with an appropriate number of cameras. In order to improve the performance of the genetic algorithm (GA), two techniques are described. The first is a distribution and estimation technique, which reduces the search space and generates camera positions for the initial GA population. The second technique is an error metric, which is integrated at GA evaluation level as an optimization function to evaluate the quality of the camera placement in a camera network. Simulation experiments show that our approach is more efficient than other approaches in terms of computation time and quality of the final camera network.

Current use of navigation system in ACL surgery: a historical review.

The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years. A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery. One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined. Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel placement; (2) improvement in knowledge of the kinematic behaviour of ACL and other structures; (3) comparison of effectiveness of different surgical techniques in controlling laxities; (4) navigation system performance to improve the outcomes of ACL reconstruction and cost-effectiveness. IV.

Is There a Role for Higher Education Institutions in Improving the Quality of First Employment?

Abstract: This paper examines the potential role of higher education institutions in reducing labour market mismatch amongst new graduates. The research suggests that increasing the practical aspects of degree programmes, irrespective of the field of study, will reduce the incidence of initial mismatch. In terms of routes into the labour market, higher education work placements with the potential to develop into permanent posts and the provision of higher education job placement assistance were found to have substantial impacts in reducing the incidence of graduate mismatch. The use of private employment agencies was found to significantly heighten the risk of subsequent mismatch.

Analyzing Innovative Training Models in Placements a Reference to Educational Sector

Rendering Work Placements for Students while at campus has become the most pivotal requisite for any modern day educational institutions these days. Competition has completely invaded this sector and need of the hour for any professional educational institution is to incorporate several unique selling propositions (USP) or value additions in its services to differentiate itself from fellow competitors. Hence, campus placement assistance provided by today's educational institutions has emerged as the single most important unique selling proposition (USP) in education industry. The idea here is to ensure survival through ideal student admissions in any fresh academic year and placement record is a important marketing tool to attract admissions. As a part of this value added assistance and also for securing sure success of this proposition towards ensuring successful admissions in a given academic year many colleges are trying to implement several unique training methodologies for its students to develop their employment specific skills for work placements. For example, college placement officer arranges a paid external agency corporate and soft skills training to its students or say a paid two day guest lecture from a professional life and smart skills trainer. However, due to deep constraints in time, cost and budget here plus university's mandatory academic activities for semesters, provision of such trainings to students at regular frequencies conflicts with their routine academic tasks. The Paper also studies the fact that during campus job drives arranged by college, students fail to apply or match their job skills learnings arranged by college to those of actual company's selection rounds for filling the open job positions. So therefore, in order to maintain a fair balance between academics and Job skills Training impartation for placements and also to bridge the widening gap between students and job markets, several ideal innovative training models are discussed in this paper which focuses on time saving, cost reduction and effort benefit for the colleges. Finally, an imperative analysis is made on the effectiveness of all these methods that should if it be put to use in real practice, can colleges realize the success of their most prominent USP of today which is definitely successful employment skills training and work placements.

Predictors of Employment Following Postsecondary Education for Vocational Rehabilitation Participants With Traumatic Brain Injury

The purpose of this study was to identify vocational rehabilitation (VR) services associated with employment outcomes of individuals with traumatic brain injury (TBI) who received college training and increased their highest level of postsecondary education completed. The participants were 1,221 individuals with TBI who increased their highest level of postsecondary education while receiving VR services. A logistic regression model containing five demographic and six VR service variables correctly classified 75.4% of cases as competitively employed or not competitively employed. The model explained approximately 10.0% of the variance in competitive employment. Significant predictors associated with competitive employment were the demographic characteristics of ethnicity and age at application. VR service variables that were significant predictors of competitive employment were (a) vocational rehabilitation counseling and guidance, (b) job readiness training, (c) job placement assistance, and (d) personal assistance services. While demographic characteristics and VR services explained a relatively small proportion of the variance in employment outcomes, more robust measurements of the variables have the potential to enhance prediction of outcomes. Provision of job readiness training and personal assistance services should be investigated further to determine the extent to which they serve as indicators of the presence of additional barriers to competitive employment.

Is There a Role for Higher Education Institutions in Improving the Quality of First Employment?

This paper examines the potential role of higher education institutions in reducing labour market mismatch amongst new graduates. The research suggests that increasing the practical aspects of degree programmes, irrespective of the field of study, will reduce the incidence of initial mismatch. In terms of routes into the labour market, higher education work placements with the potential to develop into permanent posts and the provision of higher education job placement assistance were found to have substantial impacts in reducing the incidence of graduate mismatch. The use of private employment agencies was found to significantly heighten the risk of subsequent mismatch.

AGM2015: Antineutrino Global Map 2015.

Every second greater than 1025 antineutrinos radiate to space from Earth, shining like a faint antineutrino star. Underground antineutrino detectors have revealed the rapidly decaying fission products inside nuclear reactors, verified the long-lived radioactivity inside our planet, and informed sensitive experiments for probing fundamental physics. Mapping the anisotropic antineutrino flux and energy spectrum advance geoscience by defining the amount and distribution of radioactive power within Earth while critically evaluating competing compositional models of the planet. We present the Antineutrino Global Map 2015 (AGM2015), an experimentally informed model of Earth’s surface antineutrino flux over the 0 to 11 MeV energy spectrum, along with an assessment of systematic errors. The open source AGM2015 provides fundamental predictions for experiments, assists in strategic detector placement to determine neutrino mass hierarchy, and aids in identifying undeclared nuclear reactors. We use cosmochemically and seismologically informed models of the radiogenic lithosphere/mantle combined with the estimated antineutrino flux, as measured by KamLAND and Borexino, to determine the Earth’s total antineutrino luminosity at . We find a dominant flux of geo-neutrinos, predict sub-equal crust and mantle contributions, with ~1% of the total flux from man-made nuclear reactors.

Correlating preoperative imaging with intraoperative fluoroscopy in iliosacral screw placement

BackgroundPercutaneous iliosacral screw placement can successfully stabilize unstable posterior pelvic ring injuries. Intraoperative fluoroscopic imaging is a vital component needed in safely placing iliosacral screws. Obtaining and appropriately interpreting fluoroscopic views can be challenging in certain clinical scenarios. We report on a series of patients to demonstrate how preoperative computed tomography (CT) imaging can be used to anticipate the appropriate intraoperative inlet and outlet fluoroscopic views.Materials and methods24 patients were retrospectively identified with unstable pelvic ring injuries requiring operative fixation using percutaneous iliosacral screws. Utilizing the sagittal reconstructions of the preoperative CT scans, anticipated inlet and outlet angle measurements were calculated. The operative reports were reviewed to determine the angles used intraoperatively. Postoperative CT scans were reviewed for repeat measurements and to determine the location and safety of each screw.ResultsPreoperative CT scans showed an average inlet of 20.5° (7°–37°) and an average outlet of 42.8° (30°–59°). Intraoperative views showed an average inlet of 24.9° (12°–38°) and an average outlet of 42.4° (29°–52°). Postoperative CT scans showed an average inlet of 19.4° (8°–31°) and an average outlet of 43.2° (31°–56°). The average difference from preoperative to intraoperative was 4.4° (−21° to 5°) for the inlet and 0.45° (−9° to 7°) for the outlet. The average difference between the preoperative and postoperative CT was 2.04° (0°–6°) for the inlet and 2.54° (0°–7°) for the outlet.ConclusionThere is significant anatomic variation of the posterior pelvic ring. The preoperative CT sagittal reconstruction images allow for appropriate preoperative planning for anticipated intraoperative fluoroscopic inlet and outlet views within 5°. Having knowledge of the desired intraoperative views preoperatively prepares the surgeon, aids in efficiently obtaining correct intraoperative views, and ultimately assists in safe iliosacral screw placement.Level of evidenceIV, Retrospective case series.

Behavioral, Psychological, Educational, and Vocational Interventions to Facilitate Employment Outcomes for Cancer Survivors: A Systematic Review

In the United States, an estimated 1.5 million people are diagnosed annually with some type of cancer (American Cancer Society, 2011). Work is an important stabilizing factor for cancer survivors (Arnold, 1999). De Boer and colleagues (2009) identified a rate of 33.8% unemployment among cancer survivors beyond the age of 18 compared to 15.2% among a healthy international control population. Greater awareness of the job-related and workplace issues that cancer survivors face can lead to more comprehensive rehabilitation plans and recovery (Centers for Disease Control, 2011; Nathan, Hayes-Lattin, Sisler, & Hudson, 2011). Although various recent interventions have been developed to address unemployment among cancer survivors, these have not yet been systematically evaluated.

Ultrasound assistance for central venous catheter placement in a pediatric emergency department improves placement success rates.

The use of ultrasound (US) has been shown to improve success rates and reduce complications of central venous catheter (CVC) placement in adult emergency department (ED) patients. The authors sought to determine if US assistance for CVC placement is associated with an increased success rate in pediatric ED patients. This was a retrospective cohort study of CVC placement in a pediatric ED from January 2003 to October 2011. Data were extracted from a procedure log created to record details entered by physicians at the time of CVC placement, including indication, location, complications, and information regarding use of US. All femoral vein and internal jugular vein CVC placement attempts performed by, assisted with, or directly supervised by pediatric emergency physicians (EPs) were included. Characteristics of procedures performed with and without US assistance were compared, controlling for patient and physician factors. The primary outcome was the success rate of CVC placement. There were 168 patients undergoing CVC placement attempts. The proportion of successful placement attempts was significantly higher when using US assistance (96 of 98) compared to those without (55 of 70; 98% vs. 79%, odds ratio [OR]= 13.1, 95% confidence interval [CI]=2.9 to 59.4). When controlling for patient- and physician-specific factors, success rates remained significantly higher. Ultrasound assistance was associated with greater likelihood of success in CVC placement in a pediatric ED.

Vocational rehabilitation service patterns and employment outcomes of people with epilepsy

This study aimed to examine the association between vocational rehabilitation (VR) services and employment outcomes of people with epilepsy (PWE), after controlling for demographic covariates. Data was retrieved from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year (FY) 2011. Multivariate logistic regression was used to predict employment outcomes of PWE. Of the 2030 previously unemployed PWE who received services, 884 (43.5%) achieved successful competitive employment. Results indicate that higher education level and cost of VR services consumed were positively related to successful employment. In contrast, having co-occurring anxiety/depression, receiving cash benefits, or increasing time spent in the VR system was negatively associated with employment. Eight specific VR services (e.g., education, vocational training, and job search and placement assistance) were also found to be significant predictors of employment. Services provided by state VR agencies were proven to be beneficial in improving employment outcomes. PWE should be encouraged to pursue VR services to increase the chances of attaining employment. Health care providers should also become familiar with the array of VR services.

Factors predicting the likelihood of return to work for SOCSO's return to work program participants within different employers

Background: Tackling the rising trend of workers suffering from disability due to injuries and diseases, the Malaysian Social Security Organization (SOCSO) introduced the Return to Work (RTW) Program in January 2007. The Return to Work Program provides systematic disability management for Insured Persons with employment injuries and illnesses using a bio psychosocial and multidisciplinary approach to enable them to return to work in a safe and fast manner. In this process, it is the ultimate goal of the Case Manager to place the Insured Person with injuries or illnesses back to the same employer within the same, similar or a different job. Nevertheless there are a large number of Insured Persons who fail to return to their same employer and would therefore require job placement assistance to be placed within the “different employer hierarchy”. Note: “Different employer hierarchy” refers to participants who failed to return to work with their previous employers requiring job placement assistance to be placed within new employers.Objective: This study explores factors predicting the likelihood of return to work among Insured Persons requiring job placement assistance. In the process of placing RTW participants among different employers, SOCSO has seen a drastic shift in the reception of employers wanting to employ persons with disabilities since the program was first implemented. While promotional measures and various interventions are carried out to increase number of participating employers, it is also essential that the readiness of the RTW participant themselves to return to work is evaluated at the beginning of the program to ensure that they will be mentally ready to return to work after being successfully rehabilitated.Methods: The logistic regression model was used to find significant variables from a sample size of 798 participants which may be used as indicators on the likelihood of RTW participants under job placement assistance in returning to work. Findings From the results, it was found that there were eight (8) significant variables which includes the clients self-perceived self-esteem, skills, health condition, pain tolerance, independence, self-confidence and career goals. It was also found that gender was a subsequent variable which could also be used as a predicting factor in predicting the likelihood of the participant returning to work.Discussion: In enhancing the quality and efficiency of providing job placement assistance for participants of SOCSO's Return to Work Program, significant indicators as found in this study can be used as a valuable tool in future where Case Managers may use this indicators to design interventions at the beginning of the programme . For instance, if the client had issues with self-esteem from the beginning of the program with low scores, this may suggest that additional counselling interventions and motivational programs may be required to improve the participant's self-esteem with the objective that he is able to return to work as soon as possible.

Vocational rehabilitation services and employment outcomes for adults with cerebral palsy in the United States

The aim of this study was to examine the relationship between vocational rehabilitation services provided and work outcomes among people with cerebral palsy (CP), taking in to account demographic characteristics. From the US Department of Education Rehabilitation Service Administration Case Service Report (RSA-911) database, data from 3162 individuals with CP (1820 males [57.6%] and 1342 females [42.4% age range 16-54 y) whose cases were closed in 2009, were used in this study. A total of 1567 cases (49.6%) were closed with clients being categorized as 'successful employment' and 1595 cases (50.4%) were closed with clients being classified as unemployed. Multivariate logistic regression was used to examine the relationship between services provided and work outcomes with regard to demographic characteristics. Males aged between 26 and 54 years old with higher education attainment were more likely to be employed. Individuals receiving disability benefits were less likely to be employed. After controlling for the effect of demographic and work disincentive variables, five vocational rehabilitation services significantly predicted employment outcomes (p<0.05), including (1) on-the-job training; (2) job placement assistance; (3) on-the-job support; (4) maintenance services; and (5) rehabilitation technology. Medical and health professionals need to be aware of vocational rehabilitation agencies as a resource for providing medical, psychological, educational, and vocational interventions for adults with CP to help them maximize their employability, to address their much needed work adjustment skills, to establish independent living, and to eventually reach their full potential in participation in society.

Welfare Programs That Target Workforce Participation May Negatively Affect Mortality

During the 1990s reforms to the US welfare system introduced new time limits on people's eligibility to receive public assistance. These limits were developed to encourage welfare recipients to seek employment. Little is known about how such social policy programs may have affected participants' health. We explored whether the Florida Family Transition Program randomized trial, a welfare reform experiment, led to long-term changes in mortality among participants. The Florida program included a 24-36-month time limit for welfare participation, intensive job training, and placement assistance. We linked 3,224 participants from the experiment to 17-18 years of prospective mortality follow-up data and found that participants in the program experienced a 16 percent higher mortality rate than recipients of traditional welfare. If our results are generalizable to national welfare reform efforts, they raise questions about whether the cost savings associated with welfare reform justify the additional loss of life.

Adjustments to amputation and an artificial limb in lower limb amputees

Positive adjustments to amputation and an artificial limb play important roles in the rehabilitation process. To study the different facets of adjustments to amputation and an artificial limb in lower limb amputees and to assess the possible role of different background and amputation-related factors that could potentially influence these adjustments. Cross-sectional. Adult unilateral and non-congenital lower limb amputees (n = 368) met the inclusion/exclusion criteria. Face-to-face interviews were conducted using structured questionnaires including patient's background, amputation and the Trinity Amputation and Prosthesis Experience Scales. Amputees were on average satisfied with the functioning of the prosthesis, moderately psychosocially adjusted and not restricted in performing functional and social activities, except for athletic activities. Age, employment, daily use of prosthesis and assistive device use were the most important factors associated with adjustments to amputation and prosthesis, followed by gender, co-morbidity and amputation level. Evaluation of employment status and measures to curb unemployment through vocational rehabilitation and providing assistance for placement should be intrinsic to the rehabilitation programme. Future studies are envisaged to understand the underlying factors determining the extent of daily use of prosthesis and the reasons for the use of assistive devices by the amputees. Clinical relevance Proper appraisal and measures to alleviate employment and co-morbidity, related issues, routine evaluation of daily use of prosthesis and providing appropriate gait training might facilitate immediate and long-term adjustment.