Background: Previous literature has found mixed results concerning the relationship between depression, and anxiety, and length of hospital stay among cardiac surgical patients. Given the high prevalence of these psychiatric illnesses and cardiovascular disease in Canada, a better understanding of the relationship between these variables has the potential to influence medical and psychiatric outcomes for countless individuals. Objectives: The objectives of this manuscript style thesis are to (a) describe the prevalence of mild and moderate-to-severe symptoms of depression and anxiety disorders in a sample of cardiac patients (Manuscript 1) and (b) analyze the effects of these symptoms on post-operative length of stay while controlling for potential confounding variables (Manuscript 2). Methods: This secondary analysis used data collected from a consecutive series of consenting patients attending Foothills Hospital Pre-operative Assessment Clinic (August 1998-March 2002). Patients completed the Zung Self-Rating Depression and Anxiety scales, and a questionnaire assessing potential confounders. Manuscript 1: Prevalence values and 95% intervals were calculated for mild and moderate-to-severe depression and anxiety while logistic regression was used to determine predictors of these conditions. Manuscript 2: The relationship between symptoms of depression, anxiety and length of stay was analyzed using multiple linear regression. Results: Manuscript 1: We estimated that moderate-to-severe symptoms of depression and anxiety were present in 10.66% and 3.42%, respectively. Mild depression (21.90%) and anxiety (32.89%) were also present. Common predictors of both conditions included sex, general health, and a recent myocardial infarction. Depression was further associated with co-morbid illness, as was type of surgery with anxiety. Manuscript 2: Patients with depression experienced a significant increase in length of stay compared to mentally healthy patients. Age, general health, type of surgery and education also predicted hospital stay, while anxiety did not. Conclusions: Manuscript 1: The prevalence of depression and anxiety in our sample demonstrates the need to address the burden of psychiatric illness in this population. Predictors of these disorders may assist in determining risk groups that would benefit most from psychiatric testing and interventions. Manuscript 2: The elevated length of stay observed among patients with depression supports the implementation of screening and treatment in this population. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2010-11-03 19:01:58.445

A burn injury is a disastrous trauma and can have very wide ranging impacts, including individual, family, and social. Burns patients generally have a long period of hospital stay whose accurate prediction can not only facilitate allocations of scarce medical resources but also help clinicians to counsel patients and relatives at an early stage of care. Besides prediction accuracy, prediction timing of length of hospital stay (LOS) for burn patients is also critical. Early prediction has profound effects on more efficient and effective medical resource allocations and better patient care and management. Hence, the objective of this study is to apply a backpropagation neural network (BPNN) for predicting length of hospital stay (LOS) for burn patients at early stages of care. Specifically, we defined two early-prediction timing, including admission and initial treatment stages. Prediction timing at the admission stage is to predict a burn patient¡¦s LOS when the patient is admitted into the Burns Unit. Prediction at the initial treatment stage refers to the timing right after the first surgery for burn wound excision and skin graft is performed (typically within 72 hours of injury if the patient¡¦s condition allows). Experimentally, we evaluated the prediction accuracy of these two stages, using that achieved at the post-treatment stage (referring to the timing when all surgeries for burn wound excision and skin graft are performed) as benchmarks. The evaluation results showed that prediction LOS at the admission and the initial treatment stages could attain an accuracy of 50.37% and 57.22%, respectively. Compared to the accuracy of 62.13% achieved by the post-treatment stage, the performance reached by the initial treatment stage would consider satisfactory.

OBJETIVOS: Avaliar o tempo de internação hospitalar e fatores preditores de internação prolongada após PRR realizada em instituição de ensino de alto volume cirúrgico. Objetivos secundários incluíram avaliar taxa de visitas não planejadas ao ambulatório e ao pronto-atendimento, readmissões hospitalares e taxa de complicações perioperatórias utilizando método de classificação padronizado. MÉTODOS: Foi realizada análise retrospectiva de dados prospectivamente coletados em base de dados padronizada para doentes portadores de câncer de próstata localizado submetidos a PRR no ICESP. Os procedimentos foram realizados por residentes do último ano de Urologia sob supervisão de um médico assistente (com experiência superior a 300 PRRs). Internação prolongada foi definida com internação > 2 dias (quartil superior). Um modelo de regressão logística incluindo apenas variáveis pré-operatórias foi inicialmente construído para determinar os fatores que predizem internação prolongada antes do ato cirúrgico; subsequentemente um segundo modelo incluindo tanto variáveis pré como intra e pós-operatórias foi analisado. As variáveis pré-operatórias incluídas no modelo foram: Idade, raça, IMC, PSA, índice de comorbidade de Charlson ajustado e não ajustado por idade, escore de ASA, cirurgias abdominais prévias, estádio clínico, volume prostático, Gleason da biópsia e porcentagem de fragmentos positivos, estratificação de risco NCCN. Os fatores intra e pós-operatórios incluídos na análise foram: tipo de anestesia, tempo operatório, sangramento estimado, transfusão sanguínea, preservação do feixe neurovascular, dissecção linfonodal, peso da próstata, volume tumoral, escore de Gleason do espécime, status da margem cirúrgica, estádio patológico e, finalmente, presença de complicações pós-operatórias (de acordo com o sistema de Clavien). RESULTADOS: Entre janeiro de 2010 e janeiro de 2012, 1011 pacientes foram submetidos a PRR em nossa instituição. A mediana de tempo de internação foi de 2 dias, sendo que 217 (21,5%) pacientes apresentaram internação prolongada. Os fatores preditores de internação prolongada dentre as variáveis pré-operatórias foram ICCa (OR. 1,317, IC95% 1,106-1,568, p=0,002) ou ICC não ajustado e idade separadamente (OR. 1,401, IC95% 1,118-1,756, p=0,003 e OR 1,050, IC95% 1,023-1,078, p < 0,001, respectivamente), escore de ASA 3 (OR. 3,260, IC95% 1,646-6,455, p < 0,001), volume prostático no USG-TR (OR, 1,005, IC95% 1,001-1,011, p=0,038) e raça negra (OR. 2,235, IC95% 1291-3,869, p=0,004); considerando-se também fatores intra e pós-operatórios na regressão, o tempo operatório (OR 1,007, IC95% 1,001-1,013, p=0,022) e presença de complicações de qualquer grau (OR 2,013, IC95% 1,192-3,399, p=0,009) ou complicações maiores (OR 2,357, IC95% 1,228-4,521, p=0,01) também foram correlacionados de maneira independente com internação prolongada. A taxa de readmissão hospitalar nesta série foi de 2,7%; visitas não programadas ao pronto atendimento ocorreram em 7,3% dos casos. A taxa global de complicações (intra e pós-operatórias) foi de 14,5%; a incidência de complicações pós-operatórias menores (graus 1 e 2) e maiores (Grau 3 ou 4) foi de 8,5% e 5,4%, respectivamente. CONCLUSÃO: Os fatores preditores independentes de internação prolongada dentre as variáveis pré-operatórias foram ICCa (ou ICC não ajustado e idade separadamente), escore de ASA 3, volume prostático no USG-TR e raça negra; considerando-se também fatores intra e pós-operatórios, o tempo operatório e presença de complicações de qualquer grau e complicações maiores foram correlacionados de maneira independente com internação prolongada. A identificação destes fatores permite não só auxiliar no planejamento de gastos e aconselhamento de pacientes, mas potencialmente promover modificações de variáveis que possam reduzir o tempo de admissão dos pacientes após PRR / OBJECTIVES: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution. Secondary objectives were to analyze the rate of unplanned visits to the office and emergency care, hospital readmissions and perioperative complications rates using a standardized classification system. METHODS: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution. The procedures were performed by senior residents under the supervision of a staff surgeon (with prior experience larger than 300 RRPs). Prolonged hospitalization was defined as hospital stay longer than 2 days (upper quartile). A logistic regression model including only preoperative variables was initially built to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Preoperative variables included in the model were age, race, BMI, PSA, Charlson comorbidity index (adjusted and not adjusted for age), ASA score, previous abdominal surgery, clinical stage, prostate volume, biopsy Gleason and percentage of positive cores, NCCN risk stratification. Intra and postoperative factors included in the analysis were: type of anesthesia, operative time, estimated bleeding loss, transfusion, nerve-sparing approach, lymph node dissection, prostate weight, tumor volume, Gleason score specimen, positive margin rates, pathologic stage, and, finally, the presence of postoperative complications (according to Clavien grading system). RESULTS: Between January 2010 and January 2012, 1011 patients underwent RRP at our institution. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICCa (OR. 1.317, 95% CI 1.106 to 1.568, p = 0.002) or unadjusted ICC and age separately (OR. 1.401, 95% CI 1.118 to 1.756, p = 0.003 and OR 1.050, 95% CI 1.023 to 1.078, p < 0.001, respectively), ASA score of 3 (OR. 3.260, 95% CI 1.646 to 6.455, p < 0.001), prostate volume on USG-TR (OR, 1.005; 95% CI 1.001 -1.011, p = 0.038) and African-American race (OR 2.235, 95% CI 1291 to 3.869, p = 0.004).; considering also intra and postoperative factors, operative time (OR 1.007, 95% CI 1.001 to 1.013, p = 0.022) and the presence of any complications (OR 2.013, 95% CI 1.192 to 3.399, p = 0.009) or major complications (OR 2.357, 95% CI 1.228 to 4.521, p = 0.01) were also correlated independently with prolonged hospital stay. Hospital readmission rate in this series was 2.7%; unscheduled visits to emergency care occurred in 7.3% of cases. The complication rate was 14.5%; the incidence of minor (grades 1 and 2) and major complications (Grade 3 or 4) was 8.5% and 5.4%, respectively. CONCLUSION: The independent predictors of prolonged hospitalization among the preoperative variables were ICCa (or unadjusted ICC and age separately), ASA score of 3, prostate volume on USG-TR and African-American race; considering also intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay. The identification of these factors allows not only better planning the institutional costs related to RRP but also proper counseling of patients undergoing RRP; potentially modifiable risk factors can be optimized to shorter length of hospital stay after RRP

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. > 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in group 1 and 165 in group 2 respectively). The Kaplan-Meier estimate of the median cumulative proportion of patients still hospitalized for the group 1 was 4 days and in group 2 was 5 days (log-rank test; P=0.67). In univariate analysis, Cox PH regression showed unadjusted hazard rate of discharge from hospital was slightly higher in group 1 than group 2 but was statistically non-significant (HR=1.08; P=0.70). In multivariate Cox model analysis, creatinine at the time of admission when greater than 1.6mg/dL (P=0.75), LVEF (P= 0.14), total twenty-four hours dose of intravenous Furosemide given (P=0.98) and interaction between Furosemide dose and Creatinine level (P=0.79) were not significant predictor of hospital discharge. Adjusted hazard rate for discharge from hospital was 12% higher in group 1 than group 2 but still statistically non-significant (HR=1.12; P=0.60). Since the length of hospital stay is similar between two groups, we suggest the goal of diuresis to be less than 2400mL in first twenty-four hours to prevent excessive dehydration.

OBJETIVOS: Avaliar o tempo de internação hospitalar e fatores preditores de internação prolongada após PRR realizada em instituição de ensino de alto volume cirúrgico. Objetivos secundários incluíram avaliar taxa de visitas não planejadas ao ambulatório e ao pronto-atendimento, readmissões hospitalares e taxa de complicações perioperatórias utilizando método de classificação padronizado. MÉTODOS: Foi realizada análise retrospectiva de dados prospectivamente coletados em base de dados padronizada para doentes portadores de câncer de próstata localizado submetidos a PRR no ICESP. Os procedimentos foram realizados por residentes do último ano de Urologia sob supervisão de um médico assistente (com experiência superior a 300 PRRs). Internação prolongada foi definida com internação > 2 dias (quartil superior). Um modelo de regressão logística incluindo apenas variáveis pré-operatórias foi inicialmente construído para determinar os fatores que predizem internação prolongada antes do ato cirúrgico; subsequentemente um segundo modelo incluindo tanto variáveis pré como intra e pós-operatórias foi analisado. As variáveis pré-operatórias incluídas no modelo foram: Idade, raça, IMC, PSA, índice de comorbidade de Charlson ajustado e não ajustado por idade, escore de ASA, cirurgias abdominais prévias, estádio clínico, volume prostático, Gleason da biópsia e porcentagem de fragmentos positivos, estratificação de risco NCCN. Os fatores intra e pós-operatórios incluídos na análise foram: tipo de anestesia, tempo operatório, sangramento estimado, transfusão sanguínea, preservação do feixe neurovascular, dissecção linfonodal, peso da próstata, volume tumoral, escore de Gleason do espécime, status da margem cirúrgica, estádio patológico e, finalmente, presença de complicações pós-operatórias (de acordo com o sistema de Clavien). RESULTADOS: Entre janeiro de 2010 e janeiro de 2012, 1011 pacientes foram submetidos a PRR em nossa instituição. A mediana de tempo de internação foi de 2 dias, sendo que 217 (21,5%) pacientes apresentaram internação prolongada. Os fatores preditores de internação prolongada dentre as variáveis pré-operatórias foram ICCa (OR. 1,317, IC95% 1,106-1,568, p=0,002) ou ICC não ajustado e idade separadamente (OR. 1,401, IC95% 1,118-1,756, p=0,003 e OR 1,050, IC95% 1,023-1,078, p < 0,001, respectivamente), escore de ASA 3 (OR. 3,260, IC95% 1,646-6,455, p < 0,001), volume prostático no USG-TR (OR, 1,005, IC95% 1,001-1,011, p=0,038) e raça negra (OR. 2,235, IC95% 1291-3,869, p=0,004); considerando-se também fatores intra e pós-operatórios na regressão, o tempo operatório (OR 1,007, IC95% 1,001-1,013, p=0,022) e presença de complicações de qualquer grau (OR 2,013, IC95% 1,192-3,399, p=0,009) ou complicações maiores (OR 2,357, IC95% 1,228-4,521, p=0,01) também foram correlacionados de maneira independente com internação prolongada. A taxa de readmissão hospitalar nesta série foi de 2,7%; visitas não programadas ao pronto atendimento ocorreram em 7,3% dos casos. A taxa global de complicações (intra e pós-operatórias) foi de 14,5%; a incidência de complicações pós-operatórias menores (graus 1 e 2) e maiores (Grau 3 ou 4) foi de 8,5% e 5,4%, respectivamente. CONCLUSÃO: Os fatores preditores independentes de internação prolongada dentre as variáveis pré-operatórias foram ICCa (ou ICC não ajustado e idade separadamente), escore de ASA 3, volume prostático no USG-TR e raça negra; considerando-se também fatores intra e pós-operatórios, o tempo operatório e presença de complicações de qualquer grau e complicações maiores foram correlacionados de maneira independente com internação prolongada. A identificação destes fatores permite não só auxiliar no planejamento de gastos e aconselhamento de pacientes, mas potencialmente promover modificações de variáveis que possam reduzir o tempo de admissão dos pacientes após PRR / OBJECTIVES: To evaluate the length hospital stay and predictors of prolonged hospitalization after RRP performed in a high-surgical volume teaching institution. Secondary objectives were to analyze the rate of unplanned visits to the office and emergency care, hospital readmissions and perioperative complications rates using a standardized classification system. METHODS: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution. The procedures were performed by senior residents under the supervision of a staff surgeon (with prior experience larger than 300 RRPs). Prolonged hospitalization was defined as hospital stay longer than 2 days (upper quartile). A logistic regression model including only preoperative variables was initially built to determine the factors that predict prolonged hospital stay before the surgical procedure; subsequently, a second model including both pre and intraoperative variables was analyzed. Preoperative variables included in the model were age, race, BMI, PSA, Charlson comorbidity index (adjusted and not adjusted for age), ASA score, previous abdominal surgery, clinical stage, prostate volume, biopsy Gleason and percentage of positive cores, NCCN risk stratification. Intra and postoperative factors included in the analysis were: type of anesthesia, operative time, estimated bleeding loss, transfusion, nerve-sparing approach, lymph node dissection, prostate weight, tumor volume, Gleason score specimen, positive margin rates, pathologic stage, and, finally, the presence of postoperative complications (according to Clavien grading system). RESULTS: Between January 2010 and January 2012, 1011 patients underwent RRP at our institution. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICCa (OR. 1.317, 95% CI 1.106 to 1.568, p = 0.002) or unadjusted ICC and age separately (OR. 1.401, 95% CI 1.118 to 1.756, p = 0.003 and OR 1.050, 95% CI 1.023 to 1.078, p < 0.001, respectively), ASA score of 3 (OR. 3.260, 95% CI 1.646 to 6.455, p < 0.001), prostate volume on USG-TR (OR, 1.005; 95% CI 1.001 -1.011, p = 0.038) and African-American race (OR 2.235, 95% CI 1291 to 3.869, p = 0.004).; considering also intra and postoperative factors, operative time (OR 1.007, 95% CI 1.001 to 1.013, p = 0.022) and the presence of any complications (OR 2.013, 95% CI 1.192 to 3.399, p = 0.009) or major complications (OR 2.357, 95% CI 1.228 to 4.521, p = 0.01) were also correlated independently with prolonged hospital stay. Hospital readmission rate in this series was 2.7%; unscheduled visits to emergency care occurred in 7.3% of cases. The complication rate was 14.5%; the incidence of minor (grades 1 and 2) and major complications (Grade 3 or 4) was 8.5% and 5.4%, respectively. CONCLUSION: The independent predictors of prolonged hospitalization among the preoperative variables were ICCa (or unadjusted ICC and age separately), ASA score of 3, prostate volume on USG-TR and African-American race; considering also intra and postoperative factors, operative time, presence of any complications and major complications were correlated independently with prolonged hospital stay. The identification of these factors allows not only better planning the institutional costs related to RRP but also proper counseling of patients undergoing RRP; potentially modifiable risk factors can be optimized to shorter length of hospital stay after RRP

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23118号 / 社医博第114号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 森田 智視, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Background: The incidence of neonatal opioid withdrawal syndrome (NOWS), a drug withdrawal syndrome mainly associated with opioid exposure in-utero has significantly increased in the United States over the last decade with infants with NOWS staying longer in the hospital than those without NOWS. Objectives: To determine if feeding tube use while on admission is associated with length of hospital stay among infants diagnosed with NOWS. We also compared the differences between infants with NOWS who required the use of feeding tubes while on admission, and those that did not, based on infant and maternal characteristics. Methods: This was a retrospective cohort study of infants delivered between July 1, 2011 and June 30, 2016 at Ballad Health System. Our inclusion criteria were infants who were exposed to opioids in-utero and received a diagnosis of NOWS based on 2 consecutive Finnegan scores of 10, or 3 consecutive scores of 8, or treatment with morphine. Medical chart record of 294 infants who met these criteria were reviewed for infant and maternal characteristics. Our outcome variable was infant length of hospital stay and our predictor variable was feeding tube use an indicator for feeding difficulties. Chi-square test and t-test were used to compare infant and maternal characteristics by feeding tube use. Simple linear regression models were used to assess the effect of feeding tube use and infant and maternal characteristics on infant length of hospital stay. Multiple linear regression was used to model infant length of hospital stay predicted by feeding tube use, while adjusting for neonatal intensive care unit (NICU) admission, treatment with morphine, and maternal benzodiazepine use during pregnancy. All analyses were done using SAS 9.4. Results: Of the 294 infants diagnosed with NOWS, 22.11% had feeding difficulties that necessitated use of feeding tubes. Infants who used feeding tubes were significantly more likely to be born preterm (20.31% vs 8.73%, p=0.0096) to be admitted into the NICU (98.46% vs 51.09%, p=

Prompt diagnosis and treatment of necrotizing fascitis reduces the morbidity and mortality rates of this devastating disease. To examine the clinical outcomes of using negative pressure wound therapy in the adjunctive management of wounds secondary to necrotizing fascitis, a retrospective review of medical records was conducted. Participants included 11 consecutive patients (16 wounds) with a diagnosis of necrotizing fascitis admitted to a teaching hospital between 2000 and 2005 and treated on an inpatient basis with negative pressure wound therapy. The patients included seven men, four women (average age 54 years; range 18 to 82 years). Variables abstracted from the medical records and consultation notes included: demographic information, tissue and blood bacteriological data, wound history, wound healing outcomes, duration of negative pressure wound therapy, length of hospital stay, and mortality and morbidity information. Variables were entered into an electronic database and analyzed. Operative tissue biopsies were obtained and all participants received serial surgical debridements as well as infection, nutrition, and hemodynamic support. Negative pressure wound therapy was applied to the wound(s) at 125 mm Hg continuous negative pressure until reconstructive closure could be performed. Most wounds (10) were on lower extremities, seven patients presented with sepsis, and beta-hemolytic Streptococcus was identified in nine wounds. Mean number of negative pressure wound therapy treatment days was 25 (range: 7 to 74), mean length of stay was 67 days (range: 21 to 186). All wounds were successfully closed ĝ€" 73% received split-thickness skin grafts, 27% required flaps, 100% limb salvage was achieved, and all patients survived. No negative pressure wound therapy or dressing-associated complications were observed. Negative pressure wound therapy was found to be a viable adjunctive treatment in the management of wounds associated with necrotizing fascitis.

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...