The Management of Change: A Case Study

A literature review was conducted to identify some of the requirements for competitiveness and change that are being promoted by leaders in the manufacturing field. A survey was developed based on the literature review and was subsequently administered, via the case study method, at a midwestern US agricultural chemicals firm to determine the company\u27s degree of compliance with the literature\u27\u27s recommendations. To a large degree, the company complied with the requirements

Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study.

Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA).A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey.A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation.Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures

Spinal V2b neurons reveal a role for ipsilateral inhibition in speed control

The spinal cord contains a diverse array of interneurons that govern motor output. Traditionally, models of spinal circuits have emphasized the role of inhibition in enforcing reciprocal alternation between left and right sides or flexors and extensors. However, recent work has shown that inhibition also increases coincident with excitation during contraction. Here, using larval zebrafish, we investigate the V2b (Gata3+) class of neurons, which contribute to flexor-extensor alternation but are otherwise poorly understood. Using newly generated transgenic lines we define two stable subclasses with distinct neurotransmitter and morphological properties. These V2b subclasses synapse directly onto motor neurons with differential targeting to speed-specific circuits. In vivo, optogenetic manipulation of V2b activity modulates locomotor frequency: suppressing V2b neurons elicits faster locomotion, whereas activating V2b neurons slows locomotion. We conclude that V2b neurons serve as a brake on axial motor circuits. Together, these results indicate a role for ipsilateral inhibition in speed control

Analysis of Wildfire Occurrence in Southeastern Arkansas, 1984-1987

Wildfire statistics for Arkansas Forestry Commission District I in southeastern Arkansas were analyzed for the period 1 984 through 1987. A mean of 313 fires and 1103 hectares burned annually during the study period. Most (87%) of the land burned was forested. The greatest number (90%) of wildfires occurred when fire-danger was moderate to high. Most fires were started (90%) and detected (51%) by local residents. Arson was responsible for the majority of fires (68%) and hectares burned (65%). A disproportionately high number (43%) of the incendiary fires occurred in Ashley County. Mean fire size was smaller in this county. Fire suppression professionals attribute this to increased surveillance and suppression efforts in this county as compared with other counties. Many more fires occurred in 1987 than in other years. On forest-industry land more fires occurred in1987 than in previous years (65% vs. 42%). Also, for all lands, more fires were of incendiary origin in 1987 than in previous years (78% vs. 60%). The authors provide evidence that the change in fire pattern in 1987 was due in part to a drastic change in administration of hunting privileges by a major forest industry in the area

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Human Brain Microvascular Endothelial Cells and Umbilical Vein Endothelial Cells Differentially Facilitate Leukocyte Recruitment and Utilize Chemokines for T Cell Migration

Endothelial cells that functionally express blood brain barrier (BBB) properties are useful surrogates for studying leukocyte-endothelial cell interactions at the BBB. In this study, we compared two different endothelial cellular models: transfected human brain microvascular endothelial cells (THBMECs) and human umbilical vein endothelial cells (HUVECs). With each grow under optimal conditions, confluent THBMEC cultures showed continuous occludin and ZO-1 immunoreactivity, while HUVEC cultures exhibited punctate ZO-1 expression at sites of cell-cell contact only. Confluent THBMEC cultures on 24-well collagen-coated transwell inserts had significantly higher transendothelial electrical resistance (TEER) and lower solute permeability than HUVECs. Confluent THBMECs were more restrictive for mononuclear cell migration than HUVECs. Only THBMECs utilized abluminal CCL5 to facilitate T-lymphocyte migration in vitro although both THBMECs and HUVECs employed CCL3 to facilitate T cell migration. These data establish baseline conditions for using THBMECs to develop in vitro BBB models for studying leukocyte-endothelial interactions during neuroinflammation

Recommendations To Reduce Frequent Jail Contact

Although most jail admissions represent the only contact a person will have with the criminal legal system, there is a small group of people who experience more frequent jail contact and who represent a disproportionate number of both jail admissions and expenditures. People with frequent jail contact experience complex, interconnected social, economic, and behavioral health needs that may exacerbate (or be exacerbated by) their frequent jail contact. This group also experiences frequent contact with other services in the community, such as emergency rooms, homeless shelters, and treatment facilities. Strategies to implement services that meet complex needs and address structural barriers are critical to meaningfully and sustainably reduce system involvement among the population of people who experience frequent jail contact.Effective change for people with frequent jail contact must proceed simultaneously on a systemic, policy level and on the individual services level. The population discussed in this policy brief typically has complicated behavioral and medical health needs, extensive criminal legal encounters, and significant social deficits such as poverty, isolation, and elevated risk of being unhoused. Many of their needs can be addressed with intensive, person-centered treatment in a coordinated continuum of care

Ticagrelor Reduces Thromboinflammatory Markers in Patients With Pneumonia

Despite treatment advances for sepsis and pneumonia, significant improvements in outcome have not been realized. Antiplatelet therapy may improve outcome in pneumonia and sepsis. In this study, the authors show that ticagrelor reduced leukocytes with attached platelets as well as the inflammatory biomarker interleukin (IL)-6. Pneumonia patients receiving ticagrelor required less supplemental oxygen and lung function tests trended toward improvement. Disruption of the P2Y12 receptor in a murine model protected against inflammatory response, lung permeability, and mortality. Results indicate a mechanistic link between platelets, leukocytes, and lung injury in settings of pneumonia and sepsis, and suggest possible therapeutic approaches to reduce complications. (Targeting Platelet-Leukocyte Aggregates in Pneumonia With Ticagrelor [XANTHIPPE]; NCT01883869

The Grizzly, February 10, 1984

Guards Receive Training • Internships for Credit • Alcoholism: Prime Health Problem • Businessman to Share Experiences • Fish Find a Home • China in the 20th Century • Television Forum Presented • DJ Spotlight on...Ed Johns • Two Decades of the Beatles • Grapplers Keep Rolling • Lady Bears Quash Cabrini • Bears Impressive in Win Over Drew • UC Gymnasts Post Best Score of Seasonhttps://digitalcommons.ursinus.edu/grizzlynews/1112/thumbnail.jp

The Grizzly, March 2, 1984

Reagan Proposes to Cut Student Aid: 62% Ursinus Students Could Feel Bite • Tray Offenders Discussed • Students Elect New USGA Officers • Writing Seminar Features Alumni • Presidents Corner: Frats Move in Desirable Direction • Letters to the Editor: USGA Concerned With Student Apathy; Get in Gear • Board Elects Two New Members, Appoints Seven • Women\u27s Club Plans Events • WRUC Gets Technician • The Lantern Seeks Contributions • Cogger Heads State Study • Fall Registration Looms on Horizon • Learn While You Work • Sports Profile: Mo Gorman Excels • Basketball Team Wraps Up 83-84 Season • Bears Make Tracks • Grapplers Shine At MACs: Doyle Crowned 150lb Champ; Racich Named Coach of the Year • Doyle and Paolone Successful in MAC Competition • Satisfied with Nationalshttps://digitalcommons.ursinus.edu/grizzlynews/1114/thumbnail.jp