The Effect of an Enhanced Recovery Protocol on Pediatric Colorectal Surgical Patient Outcomes at a Single Institution

Introduction Enhanced recovery protocols (ERP) have been associated with fewer postoperative complications in adult colorectal surgery patients, but there is a paucity of data on pediatric patients. Our aim is to describe the effect of an ERP, compared to conventional care, on pediatric colorectal surgical complications. Materials and Methods We performed a single institution, retrospective cohort study (2014-2020) on pediatric (≤18 years old) colorectal surgery patients pre- and post-implementation of an ERP. Bivariate analysis and logistic regression were used to assess the effect of an ERP on return visits to the emergency room, reoperation, and readmission within 30-days. Results There were 194 patients included in this study, with 54 in the control cohort and 140 in the ERP cohort. There was no significant difference in the age, BMI, primary diagnosis, or use of laparoscopic technique between the cohorts. The ERP cohort had a significantly shorter foley duration, postoperative stay, and had nerve blocks performed. After controlling for pertinent covariates, the ERP cohort experienced higher odds of reoperation within 30 days (OR 5.83, P = .04). There was no significant difference in the other outcomes analyzed. Conclusion In this study, there was no difference in the odds of overall complications, readmission or return to the ER within 30-days of surgery. However, although infrequent, there were higher odds of returns to the OR within 30 days. Future studies are needed to analyze how adherence to individual components may influence patient outcomes to ensure patient safety during ERP implementation

Talent Investments Pay Off: White Paper - Cigna Realizes Return on Investment from Tuition Benefits

Investing in college tuition as an employee benefit helps companies attract and retain top talent, but a new study of Cigna Corporation (NYSE: CI) shows there's another compelling reason for employers to embrace the benefit: it improves the bottom line.An analysis of health insurer Cigna's Education Reimbursement Program (ERP) shows every dollar the company puts into the program is returned and generates an additional $1.29 in savings—a 129 percent return on investment. Lumina Foundation, a national foundation focused on increasing postsecondary attainment partnered with Cigna to design the study, which was conducted by Accenture, a leading global professional services company."We've long known that when companies support their employees' pursuit of a postsecondary education, it improves employees' lives and addresses our nation's overall need to increase talent in our workforce," said Jamie Merisotis, president and CEO of Lumina Foundation. "With the release of this study, we also can further demonstrate that investing in employees' tuition isn't a benefit cost, but rather a valuable investment that positively impacts organizations' bottom line. That should entice more C-suite leaders to embrace this approach."The study of Cigna's ERP offers a rare glimpse at the financial impact of tuition assistance programs. About 60 percent of employers offer such support—investing an average of 10 percent of their learning and development budgets on tuition assistance—but only two to five percent of organizations evaluate the return of these investments. Cigna's study examined differences in rates of promotions, transfers, and retention between employees who took advantage of ERP and employees who did not participate from 2012 to 2014, isolating factors such as employee tenure that could impact findings.The study shows that Cigna's ERP program increases career opportunity and employee retention, which drives financial payback. Program participants are 10 percent more likely to be promoted, 7.5 percent more likely to be transferred within Cigna, and eight percent more likely to stay at the company, reducing across-the-board talent management and recruiting costs

Early Resolution for Family Law Cases in Alaska's Courts

Note: The PDF of this article includes a web supplement which did not appear in the original print version of the article.The Early Resolution Program (ERP), the first program of its kind in the nation, was developed by the Alaska Court System's Family Law Self-Help Center to provide self-represented litigants in family law cases with free legal assistance and mediation to help resolve issues and reach settlements without protracted court trials. This article discusses the ERP's goals and development, describes how cases are screened and processed, and presents ERP statistics though August 2014.[Introduction] / Goals of ERP / Beginning of ERP / Screening Considerations / How ERP Works / Modifications to Custody and Child Support Orders / Program Benefits / Conclusion / [SIDEBAR:] Early Resolution Program Timeline / [WEB SUPPLEMENT:] Issues in an ERP CaseYe

Understanding language-elicited EEG data by predicting it from a fine-tuned language model

Electroencephalography (EEG) recordings of brain activity taken while participants read or listen to language are widely used within the cognitive neuroscience and psycholinguistics communities as a tool to study language comprehension. Several time-locked stereotyped EEG responses to word-presentations -- known collectively as event-related potentials (ERPs) -- are thought to be markers for semantic or syntactic processes that take place during comprehension. However, the characterization of each individual ERP in terms of what features of a stream of language trigger the response remains controversial. Improving this characterization would make ERPs a more useful tool for studying language comprehension. We take a step towards better understanding the ERPs by fine-tuning a language model to predict them. This new approach to analysis shows for the first time that all of the ERPs are predictable from embeddings of a stream of language. Prior work has only found two of the ERPs to be predictable. In addition to this analysis, we examine which ERPs benefit from sharing parameters during joint training. We find that two pairs of ERPs previously identified in the literature as being related to each other benefit from joint training, while several other pairs of ERPs that benefit from joint training are suggestive of potential relationships. Extensions of this analysis that further examine what kinds of information in the model embeddings relate to each ERP have the potential to elucidate the processes involved in human language comprehension.Comment: To appear in Proceedings of the 2019 Conference of the North American Chapter of the Association for Computational Linguistic

Is the LAN effect in morphosyntactic processing an ERP artifact?

Available online 4 February 2019.The left anterior negativity (LAN) is an ERP component that has been often associated with morphosyntactic processing, but recent reports have questioned whether the LAN effect, in fact, exists. The present project examined whether the LAN effect, observed in the grand average response to local agreement violations, is the result of the overlap between two different ERP effects (N400, P600) at the level of subjects (n = 80), items (n = 120), or trials (n = 6160). By-subject, by-item, and by-trial analyses of the ERP effect between 300 and 500 ms showed a LAN for 55% of the participants, 46% of the items, and 49% of the trials. Many examples of the biphasic LAN-P600 response were observed. Mixed-linear models showed that the LAN effect size was not reduced after accounting for subject variability. The present results suggest that there are cases where the grand average LAN effect represents the brain responses of individual participants, items, and trials.This work was supported by the Spanish Ministry [PSI 2014-54500- P; IJCI-2016-27702; PSI2017-82941-P]; the Basque Government [PI_2015_1_25]; and the Severo Ochoa [SEV-2015-0490]