Defining the critical limit of oxygen extraction in the human small intestine

AbstractAlthough animal models have been used to characterize the relation between oxygen consumption and blood flow, reliable data have not been generated in the human small intestine. We perfused segments of human small intestine by using an ex vivo perfusion circuit that allowed precise manipulation of blood flow and perfusion pressure. Our goal was to define the critical level of intestinal blood flow necessary to maintain the metabolic needs of the tissue. Human small intestine (n = 5) tissue obtained at transplantation harvest was transported on ice to the laboratory. A 40-cm mid-jejunal segment was selected for perfusion, and appropriate inflow and outflow vessels were identified and cannulated. Perfusion with an autologous blood solution was initiated through an extracorporeal membrane oxygenation circuit. After a 30-minute equilibration period, arterial and venous blood gases were measured at varying flow rates while maintaining a constant hematocrit level. Arterial and venous oxygen content, arteriovenous oxygen difference (A-VO2 diff), and oxygen consumption (O 2 ) were then calculated. Our results demonstrated that at blood flows >30 ml/min/100 g, O 2 is independent of blood flow (1.6 ± 0.06 ml/min/100 g), and oxygen extraction is inversely related to flow. Below this blood flow rate of 30 ml/min/100 g, oxygen extraction does not increase further (6.3 ± 0.3 vol%), and O 2 becomes flow dependent. This ex vivo preparation defines for the first time a threshold value of blood flow for small intestine below which oxygen consumption decreases (30 ml/min/100 g). Previous animal studies have correlated such a decrease in oxygen consumption with functional and histologic evidence of tissue injury. This “critical” flow rate in human intestine is similar to that found previously in canine and feline intestine, but lower than that of rodent species. (J Vasc Surg 1996;23:832-8.

Tissue hydrogen ion concentration in ischemic muscle: Effects of gradual and acute arterial occlusion, with and without acute venous hypertension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22874/1/0000437.pd

Unlocking the Methodology Of Escape Rooms: Considerations For Conducting Applied Escape Rooms in Research

Background. Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose. The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion. The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data

Advancing Team Cohesion: Using an Escape Room as a Novel Approach

Objective: An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods: This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post- escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results: Sixty-two teams participated (n 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) 24.10, p \u3c .001; Wilks’ K .725; partial g2 .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions: This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums

The problem of assessing problem solving: can comparative judgement help?

This definitive version of this paper is available at Springerlink: http:dx.doi.org/10.1007/s10649-015-9607-1School mathematics examination papers are typically dominated by short, structured items that fail to assess sustained reasoning or problem solving. A contributory factor to this situation is the need for student work to be marked reliably by a large number of markers of varied experience and competence. We report a study that tested an alternative approach to assessment, called comparative judgement, which may represent a superior method for assessing open-ended questions that encourage a range of unpredictable responses. An innovative problem solving examination paper was specially designed by examiners, evaluated by mathematics teachers, and administered to 750 secondary school students of varied mathematical achievement. The students’ work was then assessed by mathematics education experts using comparative judgement as well as a specially designed, resourceintensive marking procedure. We report two main findings from the research. First, the examination paper writers, when freed from the traditional constraint of producing a mark scheme, designed questions that were less structured and more problem-based than is typical in current school mathematics examination papers. Second, the comparative judgement approach to assessing the student work proved successful by our measures of inter-rater reliability and validity. These findings open new avenues for how school mathematics, and indeed other areas of the curriculum, might be assessed in the future

Renal:Systemic renin indices and renal vein renin ratios as prognostic indicators in remedial renovascular hypertension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21815/1/0000215.pd

Prostaglandin F2[alpha] attenuation of aortic declamping hyperemia and hypotension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21783/1/0000178.pd

Unlocking the Methodology Of Escape Rooms: Considerations For Conducting Applied Escape Rooms in Research

Background. Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose. The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion. The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data

Unlocking the Methodology Of Escape Rooms: Considerations For Conducting Applied Escape Rooms in Research

Background. Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose. The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion. The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data