The 3s Spreadsheet Test (3S Test) is a cancellation test with high stimulus density and low target-to-distractor ratio, to assess stimulus-centered and viewer-centered spatial neglect. Twenty-five stroke survivors with left-sided neglect and 68 age-matched healthy controls took the 3S Test. Patients also took the Apples Test, a validated cancellation test. No patient's accuracy on the 3S Test was in the normal range. A total of 91.7% of the patients had an abnormal start; 52.6% of the patients took abnormally long time to complete the 3S Test. The 3S and Apples Tests agreed poorly on both the viewer-centered and stimulus-centered neglect classifications (κ = .25 and .05, respectively), but consistently identified 8 of the 25 patients (32%) as having both forms of neglect while each isolated form of neglect was present in one patient (4%). Lesion data were consistent with previous studies. These findings suggest that the 3S Test is a sensitive cancellation test for assessing viewer-centered and stimulus-centered spatial neglect. We are currently developing the 3S Test version 2 to refine the test stimuli and the scoring procedure.
Background Patients diagnosed with complex hepato-pancreaticobiliary (HPB) conditions experience a complex journey through the health care system. Patient navigation is commonly offered to patients and their caregivers throughout this complex journey. We developed and tested a prototype web-based dual (patient and provider) navigation application ‘PatientNav’. We report on phase I of the study, which evaluated the app in multiple domains: usability, functionality, and reliability. Methods Evidence-based recommendations determined throughout a needs assessment. PatientNav app was designed to be a highly customizable tool based both on needs of the patient, care team and characteristics of the institution. Our phase I pilot trial targeted individuals aged 18 years or older who reported the capacity to use a mobile app or desktop website presenting to our HPB transplant clinic at MedStar Georgetown University Hospital/Lombardi Comprehensive Cancer Center over a 2-month period. Usability, functionality, and reliability testing was conducted by applying multiple strategies that include biometric data analysis, task completion, questionnaires, and interviews. Results The usability rate of PatientNav among patient app users was 95.4%. Out of 22 patients, 18 (81.8%) completed the in-app survey whose responses were included in the analysis. Among patient app users who completed the in-app survey questionnaire, 66.6% reported that content in PatientNav app was relevant. In terms of reliability of the app, none of the patient app users reported issues with technical issues with accessing PatientNav throughout the study period. To further elucidate the characteristics of individuals who exhibited high usage of the PatientNav assigned task functions, we divided our cohort based on median number of tasks used (N = 75 total tasks). Univariable comparison showed that high function users were older with a median (IQR) of 61.5 (57.8, 71.3) compared to 52.2 (34.5, 65.7) years among low function users. No differences were observed based on gender, racial distribution, living condition or occupation. However, 41.7% of low function users had Medicare/Medicaid insurance whereas all high function users had private or combined insurance. Conclusion Our phase I pilot study showed that PatientNav is a feasible, usable and functional technological tool that enables patients with complex HPB diagnoses and their care team to interface in real time using PROMs. PatientNav is a reliable tool that can be used by clinical and support staff to help navigate patients through surgery and aftercare, and by patients to assist in navigation and self-management. Trial Registration: The trial was registered at ClinicalTrials.gov; Registration number: NCT04892927; date of registration: 5/19/2021.
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Heresies among the laity or in the schools before the sixteenth century had not flourished, but generally withered on the vine, chiefly because they had failed to win widespread support among the clergy charged with the care and instruction of souls. But in the first quarter of the century, the propagators of new doctrines were aided and abetted in their work by the sad state of the clergy, their venality, their ignorance both of Sacred Scripture and of the genuine teaching of the Church. The need for a serious reform of the clergy was recognized not only by the teachers of new and strange doctrines, but also by those genuinely devoted to the Church and orthodoxy.' But it remains true that: 'The Reformation is, primarily, and necessarily, a revolt of clerics against clerics." It was the clergy, as a group, which held the key to the floodgates which would either have contained or loosed the deluge of false doctrine.The attack upon the clergy, then, was one of the central points of strategy in the Reform movement. Evidence of the vital role of the clergy and the institution of the priesthood is given by no less a person than King Henry VIII in his Assertio Septem Sacramentorum where he wrote: 'For what other thing does he endeavour to do who tries to take away the Sacrament of Orders than this, that after the ministers of the mysteries have been vilified, they might begin to vilify the sacraments which are administered by villains." And again, 'But indeed as it were the source of all heresies is that which denies that Orders is a sacrament, for when that is taken away, it necessarily follows that the other streams (of grace) dry up.'4 Cf. Sermo Exhortatorius of William de Meltham, Chancellor of York and at one time Fisher's master at Michaelhouse, Cambridge, and the Dialogue of Sir Thomas More, Knight, Book 111, as examples of contemporary efforts to reform the clergy from within the Church. For a general description of the state of the English clergy and attempts at reform in the first part of the sixteenth century, cf. P. Hughes, The Reformation in England (London, 1950), vol. I, part I, chapters two and three, passim. P. Hughes, op. cit., p. 122. Henry VIII, Assertio Septem Sacramentorum (London: Robert Pynson, 1519): 'De Sacramento Ordinis. Nam quid aliud molitur, qui conatur tollere sacrosanctum sacramentum ordinis, quam ut postquam mysteriorum ministri viluerint, incipiant. utpote etiam, quae per viles ministrentur, vilefacere sacramenta!''Sed ornnium @-~aeresium], veluti quidam fons est, quod ordinem negat esse sacramentum, quo obstructo, caeteros necesse est rivulos exarescere' (ibid.). One wonders if Henry later reflected on this in his dealings with the English clergy. 260 ST J O H N FISHER'S DEFENCE OF THE HOLY PRIESTHOOD 261The important position held by the clergy and the decisive role they played in this movement of Reform is, perhaps, nowhere better illustrated in the literature of the time than in the writings of two men, both of them priests and both of them alive to the need for reform. One had be...
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