Distributed-Pair Programming can work well and is not just Distributed Pair-Programming

Background: Distributed Pair Programming can be performed via screensharing or via a distributed IDE. The latter offers the freedom of concurrent editing (which may be helpful or damaging) and has even more awareness deficits than screen sharing. Objective: Characterize how competent distributed pair programmers may handle this additional freedom and these additional awareness deficits and characterize the impacts on the pair programming process. Method: A revelatory case study, based on direct observation of a single, highly competent distributed pair of industrial software developers during a 3-day collaboration. We use recordings of these sessions and conceptualize the phenomena seen. Results: 1. Skilled pairs may bridge the awareness deficits without visible obstruction of the overall process. 2. Skilled pairs may use the additional editing freedom in a useful limited fashion, resulting in potentially better fluency of the process than local pair programming. Conclusion: When applied skillfully in an appropriate context, distributed-pair programming can (not will!) work at least as well as local pair programming

Ray-based description of normal mode amplitudes in a range-dependent waveguide

An analogue of the geometrical optics for description of the modal structure of a wave field in a range-dependent waveguide is considered. In the scope of this approach the mode amplitude is expressed through solutions of the ray equations. This analytical description accounts for mode coupling and remains valid in a nonadiabatic environment. It has been used to investigate the applicability condition of the adiabatic approximation. An applicability criterion is formulated as a restriction on variations of the action variable of the ray.Comment: 11 pages, 5 figure

Secondary bacterial infections of buruli ulcer lesions before and after chemotherapy with streptomycin and rifampicin

Buruli ulcer (BU), caused by Mycobacterium ulcerans is a chronic necrotizing skin disease. It usually starts with a subcutaneous nodule or plaque containing large clusters of extracellular acid-fast bacilli. Surrounding tissue is destroyed by the cytotoxic macrolide toxin mycolactone produced by microcolonies of M. ulcerans. Skin covering the destroyed subcutaneous fat and soft tissue may eventually break down leading to the formation of large ulcers that progress, if untreated, over months and years. Here we have analyzed the bacterial flora of BU lesions of three different groups of patients before, during and after daily treatment with streptomycin and rifampicin for eight weeks (SR8) and determined drug resistance of the bacteria isolated from the lesions. Before SR8 treatment, more than 60% of the examined BU lesions were infected with other bacteria, with Staphylococcus aureus and Pseudomonas aeruginosa being the most prominent ones. During treatment, 65% of all lesions were still infected, mainly with P. aeruginosa. After completion of SR8 treatment, still more than 75% of lesions clinically suspected to be infected were microbiologically confirmed as infected, mainly with P. aeruginosa or Proteus miriabilis. Drug susceptibility tests revealed especially for S. aureus a high frequency of resistance to the first line drugs used in Ghana. Our results show that secondary infection of BU lesions is common. This could lead to delayed healing and should therefore be further investigated

A randomised controlled trial and cost-effectiveness evaluation of "booster" interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

Background: Systematic reviews have identified a range of brief interventions which increase physical activity in previously sedentary people. There is an absence of evidence about whether follow up beyond three months can maintain long term physical activity. This study assesses whether it is worth providing motivational interviews, three months after giving initial advice, to those who have become more active. Methods/Design: Study candidates (n = 1500) will initially be given an interactive DVD and receive two telephone follow ups at monthly intervals checking on receipt and use of the DVD. Only those that have increased their physical activity after three months (n = 600) will be randomised into the study. These participants will receive either a "mini booster" (n = 200), "full booster" (n = 200) or no booster (n = 200). The "mini booster" consists of two telephone calls one month apart to discuss physical activity and maintenance strategies. The "full booster" consists of a face-to-face meeting with the facilitator at the same intervals. The purpose of these booster sessions is to help the individual maintain their increase in physical activity. Differences in physical activity, quality of life and costs associated with the booster interventions, will be measured three and nine months from randomisation. The research will be conducted in 20 of the most deprived neighbourhoods in Sheffield, which have large, ethnically diverse populations, high levels of economic deprivation, low levels of physical activity, poorer health and shorter life expectancy. Participants will be recruited through general practices and community groups, as well as by postal invitation, to ensure the participation of minority ethnic groups and those with lower levels of literacy. Sheffield City Council and Primary Care Trust fund a range of facilities and activities to promote physical activity and variations in access to these between neighbourhoods will make it possible to examine whether the effectiveness of the intervention is modified by access to community facilities. A one-year integrated feasibility study will confirm that recruitment targets are achievable based on a 10% sample.Discussion: The choice of study population, study interventions, brief intervention preceding the study, and outcome measure are discussed

Dynamic ‘Spot Sign’ Resolution following INR Correction in a Patient with Warfarin-Associated Intracerebral Hemorrhage

Hematoma expansion in intracerebral hemorrhage is associated with poor clinical outcome. The ‘spot sign’ is a radiological marker that is associated with hematoma expansion, and thought to represent active extravasation of contrast. This case demonstrates the use of dynamic CT angiography in identifying the time-dependent appearance of a spot sign in a patient with warfarin-associated intracerebral hemorrhage. Repeat imaging is also presented which verified cessation of the spot sign after INR correction

Archeological Of The Proposed FM 1626 Pass-Through Toll Project From Ranch-To-Market 967 To Farm-To-Market 2770 In Hays County, Texas

Hicks & Company archeologists conducted an intensive, 100-percent linear archeological survey of approximately 3.3 miles of proposed expansions to Farm-to-Market (FM) 1626 west of the city of Buda, Hays County, Texas. The survey was conducted between July 2008 and October 2016 for compliance with the Antiquities Code of Texas and Section 106 of the National Historic Preservation Act on behalf of Hays County, the project engineer Klotz Associates, and the Texas Department of Transportation (TxDOT). The Area of Potential Effects (APE) for the proposed project is composed of 54.3 acres of existing right of way and 8.08 acres of proposed expanded right of way (measuring 62.38 acres of existing plus proposed expanded right of way), and approximately 1.07 acres of temporary construction easements located outside of the existing or proposed right of way. While the proposed expanded right of way corridor has been determined, the project engineer requested that a 200-foot-wide corridor be investigated (extending 100 feet in either direction from the existing centerline) to allow for flexibility in road design, potential utility relocation, and other possible areas of concern, resulting in a total of approximately 81 acres of land surveyed. Investigations were coordinated with the Texas Historical Commission through TxDOT under Texas Antiquities Committee Permit Number 4981. On three occasions between July 28, 2008, and August 10, 2009 Hicks & Company archeologists conducted an intensive linear archeological survey of the proposed FM 1626 improvements project west of the city of Buda, Texas, on behalf of Hays County and TxDOT, returning to the field on January 21, 2016 to survey for proposed temporary construction easements located outside of the existing right of way or proposed new right of way, and again on October 26, 2016 to survey proposed new right of way in previously inaccessible parcels, completing the survey. The survey consisted of pedestrian inspection supplemented by shovel testing (N=102) and mechanical backhoe trench excavations (N=7) in the area north of Onion Creek. One backhoe trench excavated on the north bank of Onion Creek was positive for two pieces of lithic debitage, along with 32 shovel tests throughout the APE that were positive for cultural materials. One previously unrecorded site (Site 41HY449) was documented during the survey. This prehistoric surficial scatter does not meet the significance criteria for listing on the National Register of Historic Places (NRHP) or as a State Antiquities Landmark (SAL). In addition to this newly recorded site, archeologists visited elements of seven previously recorded sites (Sites 41HY199-202, 41HY209-210, and 41HY219) within the APE. Elements of one of these, Site 41HY200, could not be found within the archeological APE. Of these, only elements of Site 41HY201 are considered to have potential to deem the site eligible for inclusion on the NRHP or for designation as an SAL. The project engineer has altered plans in the vicinity of the site to avoid impacts to those resources. All other sites were found to be heavily disturbed, no longer extant, or within shallow surficial contexts atop bedrock with limited research value. Archeologists also visited the expansion areas adjacent to historic Barton Cemetery. Although the cemetery lies in close proximity to the APE, the County proposes no expansions in the immediate vicinity of the cemetery beyond a proposed retaining wall with riprap slope within the existing right of way outside the cemetery. This retaining wall is to be constructed approximately ten feet within current existing right of way. By design, retaining walls planned for this project will be fixed in place to concrete leveling pads set in place on top of the current grade and supported by earth reinforcement buildup of imported fill material. During survey, an overgrown road or trail that follows the current cemetery fenceline reinforces the assumption that the existing cemetery boundary served as the historic boundary as well, significantly reducing the potential for unmarked burials to be located within the current archeological APE. Construction within the APE is recommended to proceed with no further cultural resources investigation. The current investigations followed a no-collection policy. All projectrelated records, forms, and photographs will be permanently housed at the Texas Archeological Research Laboratory in Austin, Texas

Structuring specification in Z to build a unifying framework for hypertext systems

A report is given on work undertaken to produce a structured specification in Z of a model which aims to capture the essential abstractions of hypertext systems. The specification is presented in part and the potential value of this specification to the hypertext community is explored and discussed. We argue that this specification provides a framework for hypertext systems in that it provides: explicit and unambiguous definitions of hypertext terms, an explicit environment for the presentation, comparison and evaluation of hypertext systems and a foundation for future research and development in the field. Although there are many formal reference models of hypertext, we have found Z expressive enough to allow a unified account of a system and its operations. Our model does not restrict the specifier to any particular design, but provides a mathematical framework within which different models may be compared. Further, we were able to structure the specification in order that the model could be described initially at the highest level of abstract with complexity added at increasingly lower levels of abstraction. This structure

An Opioid-Minimizing Multimodal Pain Regimen Reduces Opioid Exposure and Pain in Trauma-Injured Patients at High Risk for Opioid Misuse: Secondary Analysis From the Mast Trial

BACKGROUND: Screening to identify patients at risk for opioid misuse after trauma is recommended but not commonly used to guide perioperative opioid management interventions. The Multimodal Analgesic Strategies for Trauma trial demonstrated that an opioid-minimizing multimodal pain regimen reduced opioid exposure in a heterogeneous trauma patient population. Here, we assess the efficacy of the Multimodal Analgesic Strategies for Trauma multimodal pain regimen in a critical patient subgroup who screened at high risk for opioid misuse. METHODS: The Multimodal Analgesic Strategies for Trauma trial compared an opioid-minimizing multimodal pain regimen (oral acetaminophen, naproxen, gabapentin, lidocaine patch, as-needed opioid) against an original multimodal pain regimen (intravenous followed by oral acetaminophen, 48-hour celecoxib and pregabalin, followed by naproxen and gabapentin, scheduled tramadol, as-needed opioid), in a randomized trial conducted from April 2018 to March 2019. A total of 631 enrolled patients were classified either as low- or high-risk via the Opioid Risk Tool. Bayesian analyses evaluated the moderating influence of Opioid Risk Tool risk (high/low) on the effect of Multimodal Analgesic Strategies for Trauma multimodal pain regimen (versus original) on opioid exposure (morphine milligram equivalents/day), opioids prescribed at discharge, and pain scores. RESULTS: Multimodal Analgesic Strategies for Trauma multimodal pain regimen effectively reduced morphine milligram equivalents/day in low- and high-Opioid Risk Tool risk groups. Moderation was observed for opioids at discharge and pain scores; Multimodal Analgesic Strategies for Trauma multimodal pain regimen was effective in the high-risk group only (opioids at discharge: 63% vs 77%, relative risk = 0.86, 95% Bayesian credible interval [0.66-1.08], posterior probability (relative risk CONCLUSION: This study is the first to show the moderating influence of opioid misuse risk on the effectiveness of an opioid-minimizing multimodal pain regimen. The Opioid Risk Tool was useful in identifying high-risk patients for whom the Multimodal Analgesic Strategies for Trauma multimodal pain regimen is recommended for perioperative pain management

An Opioid-Minimizing Multimodal Pain Regimen Reduces Opioid Exposure and Pain in Trauma-Injured Patients at High Risk for Opioid Misuse: Secondary Analysis from the Mast Trial

BACKGROUND: Screening to identify patients at risk for opioid misuse after trauma is recommended but not commonly used to guide perioperative opioid management interventions. The Multimodal Analgesic Strategies for Trauma trial demonstrated that an opioid-minimizing multimodal pain regimen reduced opioid exposure in a heterogeneous trauma patient population. Here, we assess the efficacy of the Multimodal Analgesic Strategies for Trauma multimodal pain regimen in a critical patient subgroup who screened at high risk for opioid misuse. METHODS: The Multimodal Analgesic Strategies for Trauma trial compared an opioid-minimizing multimodal pain regimen (oral acetaminophen, naproxen, gabapentin, lidocaine patch, as-needed opioid) against an original multimodal pain regimen (intravenous followed by oral acetaminophen, 48-hour celecoxib and pregabalin, followed by naproxen and gabapentin, scheduled tramadol, as-needed opioid), in a randomized trial conducted from April 2018 to March 2019. A total of 631 enrolled patients were classified either as low- or high-risk via the Opioid Risk Tool. Bayesian analyses evaluated the moderating influence of Opioid Risk Tool risk (high/low) on the effect of Multimodal Analgesic Strategies for Trauma multimodal pain regimen (versus original) on opioid exposure (morphine milligram equivalents/day), opioids prescribed at discharge, and pain scores. RESULTS: Multimodal Analgesic Strategies for Trauma multimodal pain regimen effectively reduced morphine milligram equivalents/day in low- and high-Opioid Risk Tool risk groups. Moderation was observed for opioids at discharge and pain scores; Multimodal Analgesic Strategies for Trauma multimodal pain regimen was effective in the high-risk group only (opioids at discharge: 63% vs 77%, relative risk = 0.86, 95% Bayesian credible interval [0.66-1.08], posterior probability (relative risk CONCLUSION: This study is the first to show the moderating influence of opioid misuse risk on the effectiveness of an opioid-minimizing multimodal pain regimen. The Opioid Risk Tool was useful in identifying high-risk patients for whom the Multimodal Analgesic Strategies for Trauma multimodal pain regimen is recommended for perioperative pain management