Predicting the Risk of Obstructive Sleep Apnea and Difficult Endotracheal Intubation in a Surgical Population in a Rural Community Hospital Setting

Purpose: The purpose of this paper is to provide a theoretical framework with practical application for facilitating patient flow through the operative process using the Lean philosophy to minimized delays and cancellations. Theoretical orientation: Efficient, quality patient care has always been the hallmark of Nurse Anesthetist practice. Lean healthcare introduces continuous quality improvement (CQI) processes used in Lean manufacturing to the healthcare system. The principal aspect of Lean healthcare is the concept of a value stream where work is standardized, work flow is streamlined and waste is eliminated, thus creating value. Nature of Review: In the surgical suite waits, delays and cancellation are endemic. Lean healthcare views these as waste in the system. They must be eliminated to provide value to the patient, who is the ultimate customer. Managing the flow of the patient successfully through this process will increase the quality of patient care ( value ), increase patient and provider satisfaction, increase operating room efficiency and reduce cost. Nurse Anesthetists are uniquely positioned in the operative arena to accomplish this. The greatest opportunity to reduce delays and cancellations is seen with smoothing the inter-daily workload. Successful interventions to accomplish this include: 1) maximizing the preoperative anesthesia assessment, 2) standardizing and streamlining work during the perioperative phase to minimize turn over time, and 3) adequate staffing levels to optimize postoperatively care

The dietary impact of the Norman Conquest: A multiproxy archaeological investigation of Oxford, UK

Archaeology has yet to capitalise on the opportunities offered by bioarchaeological approaches to examine the impact of the 11th-century AD Norman Conquest of England. This study utilises an integrated multiproxy analytical approach to identify and explain changes and continuities in diet and foodways between the 10th and 13th centuries in the city of Oxford, UK. The integration of organic residue analysis of ceramics, carbon (δ13C) and nitrogen (δ15N) isotope analysis of human and animal bones, incremental analysis of δ13C and δ15N from human tooth dentine and palaeopathological analysis of human skeletal remains has revealed a broad pattern of increasing intensification and marketisation across various areas of economic practice, with a much lesser and more short-term impact of the Conquest on everyday lifestyles than is suggested by documentary sources. Nonetheless, isotope data indicate short-term periods of instability, particularly food insecurity, did impact individuals. Evidence of preferences for certain foodstuffs and cooking techniques documented among the elite classes were also observed among lower-status townspeople, suggesting that Anglo-Norman fashions could be adopted across the social spectrum. This study demonstrates the potential for future archaeological research to generate more nuanced understanding of the cultural impact of the Norman Conquest of England, while showcasing a method which can be used to elucidate the undocumented, everyday implications of other large-scale political events on non-elites

Chiral discrimination in optical trapping and manipulation

When circularly polarized light interacts with chiral molecules or nanoscale particles powerful symmetry principles determine the possibility of achieving chiral discrimination, and the detailed form of electrodynamic mechanisms dictate the types of interaction that can be involved. The optical trapping of molecules and nanoscale particles can be described in terms of a forward-Rayleigh scattering mechanism, with trapping forces being dependent on the positioning within the commonly non-uniform intensity beam profile. In such a scheme, nanoparticles are commonly attracted to local potential energy minima, ordinarily towards the centre of the beam. For achiral particles the pertinent material response property usually entails an electronic polarizability involving transition electric dipole moments. However, in the case of chiral molecules, additional effects arise through the engagement of magnetic counterpart transition dipoles. It emerges that, when circularly polarized light is used for the trapping, a discriminatory response can be identified between left- and right-handed polarizations. Developing a quantum framework to accurately describe this phenomenon, with a tensor formulation to correctly represent the relevant molecular properties, the theory leads to exact analytical expressions for the associated energy landscape contributions. Specific results are identified for liquids and solutions, both for isotropic media and also where partial alignment arises due to a static electric field. The paper concludes with a pragmatic analysis of the scope for achieving enantiomer separation by such methods

The impact of a supplementary medication review and counselling service within the oncology outpatient setting

The impact on the care of breast cancer patients, of a pharmacy technician-led medication review and counselling clinic, provided in an outpatient setting, was investigated using a controlled randomised study. Compared to the controls, clinic patients showed a significantly improved level of understanding of their chemotherapy support medication (95% CI for difference in mean knowledge rating scores=2.165–2.826, P<0.001) and a significant reduction in the median number of support items required (two compared to five in the control, P<0.001). This resulted in a significant reduction in mean medication expenditure per patient (£26.70 vs £10.20, 95% CI for the mean difference in cost £6.72–£26.26, P<0.001). The clinic was also associated with significant reductions in chemotherapy delays (P<0.001) and dose reductions due to side effects (P=0.003). Other benefits from the clinic were a reduction in pharmacy dispensing time and a highly significant reduction in pharmacy time spent resolving post-clinic prescription queries (P<0.001). Taking into account the initial technician training cost, the scheme represented an annual saving to the Trust of over £15 000. The clinic serves as a model for those wishing to improve outpatient services to breast cancer patients

"A calorie is a calorie" violates the second law of thermodynamics

The principle of "a calorie is a calorie," that weight change in hypocaloric diets is independent of macronutrient composition, is widely held in the popular and technical literature, and is frequently justified by appeal to the laws of thermodynamics. We review here some aspects of thermodynamics that bear on weight loss and the effect of macronutrient composition. The focus is the so-called metabolic advantage in low-carbohydrate diets – greater weight loss compared to isocaloric diets of different composition. Two laws of thermodynamics are relevant to the systems considered in nutrition and, whereas the first law is a conservation (of energy) law, the second is a dissipation law: something (negative entropy) is lost and therefore balance is not to be expected in diet interventions. Here, we propose that a misunderstanding of the second law accounts for the controversy about the role of macronutrient effect on weight loss and we review some aspects of elementary thermodynamics. We use data in the literature to show that thermogenesis is sufficient to predict metabolic advantage. Whereas homeostasis ensures balance under many conditions, as a general principle, "a calorie is a calorie" violates the second law of thermodynamics

An examination of a modified Yo-Yo test to measure intermittent running performance in rugby players

This is an Accepted Manuscript of an article published by Taylor & Francis in European Journal of Sport Science on 17/06/2018, available online: https://doi.org/10.1080/17461391.2018.1475509This study examined how starting each shuttle in the prone position altered the internal, external and perceptual responses to the Yo-Yo Intermittent Recovery Test Level 1. Using a randomized crossover design, 17 male rugby players completed the Yo-Yo IR1 and prone Yo-Yo IR1 on two separate occasions. External loads (via microtechnology), V ̇O2, heart rate (HR), rating of perceived exertion (RPE) were measured at 160, 280 and 440 m (sub-maximal) and when the test was terminated (peak). The pre-to-post change in blood lactate concentration (∆[La]b) was determined for both tests. All data were analysed using effect sizes and magnitude-based inferences. Between-trial differences (ES 90%CL) indicated total distance was most likely lower (-1.87 0.19), whereas other measures of peak external load were likely to very likely higher during the prone Yo-Yo IR1 (0.62-1.80). Sub-maximal RPE was likely to most likely higher (0.40-0.96) and peak RPE very likely higher (0.63 0.41) in the prone Yo-Yo IR1. The change in [La]b was likely higher after the prone Yo-Yo IRl. Mean HR was possibly lower at 440 m (-0.25 0.29) as was peak HR (-0.26 0.25) in the prone Yo-Yo IR1. "V" ̇E, "V" ̇O2 and "V" ̇CO2 were likely to very likely higher at 280 and 440 m (ES = 0.36-1.22), while peak values were possibly to likely higher (ES = 0.23-0.37) in the prone Yo-Yo IR1. Adopting a prone position during the Yo-Yo IR1 increases the internal, perceptual and external responses, placing greater emphasis on metabolically demanding actions typical of rugby

Researching Complex Interventions in Health: The State of the Art : Exeter, UK. 14-15 October 2015.

Erratum to this paper available at http://hdl.handle.net/10871/23087

Discriminatory optical force for chiral molecules

We suggest that the force F exerted upon a chiral molecule by light assumes the form F = a∇w + b∇h under appropriate circumstances, where a and b pertain to the molecule whilst w and h are the local densities of electric energy and helicity in the optical field; the gradients ∇ of these quantities thus governing the molecule’s centre-of-mass motion. Whereas a is identical for the mirror- image forms or enantiomers of the molecule, b has opposite signs; the associated contribution to F therefore pointing in opposite directions. A simple optical field is presented for which ∇w vanishes but ∇h does not, so that F is absolutely discriminatory. We then present two potential applications: a Stern–Gerlach-type deflector capable of spatially separating the enantiomers of a chiral molecule and a diffraction grating to which chiral molecules alone are sensitive; the resulting diffraction patterns thus encoding information about their chiral geometry