Length of Stay for Laparoscopic Cholecystectomy

Background: Hospitals seek to maximize efficiency in stabilizing and discharging post-operative patients. The post-operative length of stay (LOS) for laparoscopic cholecystectomy surgeries in the short stay unit of a community hospital in the Portland area varies significantly with an average LOS of 170 minutes. Purpose: The purpose of this study was to isolate factors associated with decreased post-operative LOS for laparoscopic cholecystectomy surgeries to identify procedural changes that would help meet the goal of an average 120 minutes LOS. Methods: EPIC charts of 41 patients who received a laparoscopic cholecystectomy since July 1st 2014 were reviewed for data on specific factors of perioperative care. A literature review was also conducted to gather information on evidence based standards of care. Results: Data showed no differences in post-operative LOS for laparoscopic cholecystectomy patients based on gender, use of a nerve block, or pre-operative Xanax administration. Patients with the shortest LOS, under 120 minutes, received an average of three different antiemetics. Evidence based literature recommends using a combination of antiemetics during surgery to prevent post-operative nausea and vomiting (PONV). Discussion/Recommendation: PONV is a leading factor contributing to increased length of stay. The results of this study, along with evidence-based literature, suggests that a combination of at least three antiemetics during surgery can decrease PONV and thus decrease post-operative LOS for laparoscopic cholecystectomies

Practical Strategies and Advice for Managing Ethical Concerns in End-of-Life Research

poster abstractProblem/Issue Statement A growing national interest in improving end-of-life care has increased the amount of research involving dying patients and their families. However, questions about how to best balance the pressing need for research with protecting participants trouble both investigators and institutional review boards (IRBs). Furthermore, ethical concerns were identified as a potential barrier to advancing end-of-life science at the 2004 NIH State of the Science Consensus Conference. This NIH-funded study describes ethical concerns and practical strategies for managing ethical challenges in the conduct of end-of-life research. Description of Research Methods: A qualitative, exploratory case study design followed the development of end-of-life research from proposal generation through the review process. Inclusion criteria mirrored those used in the NIH State of the Science Report. Cases were identified through a search of active studies in the NIH RePORT database and an internet search of active research funded by private foundations and institutions. Data were collected from a purposive sample of 34 principal investigators who participated by phone in semistructured interviews and provided document data regarding their experiences with the grant and IRB review processes. Interviews were recorded and transcribed with identifying information removed to protect confidentiality. Relevant document data were extracted and de-identified. Data were analyzed using exploratory qualitative case study methods. Results: The most common ethical concerns about research with end-of-life populations were recruitment strategies, the burden of study procedures, and population vulnerability. Strategies to address these concerns included gathering data about the benefits of research participation, consulting with the IRB and with more experienced researchers, using non-threatening language in the consent and other materials, being flexible in data collection protocols to accommodate participant limitations, creating back-up plans in the event of crisis, partnering with clinicians to ensure prompt attention to symptom reports, and addressing the training and emotional needs of research staff . PIs advise IRBs to seek out expert consultants for end-of-life studies, work collaboratively with investigators, simplify the consent process, and be open to the benefits of research participation for dying patients and their families rather than assuming harm will occur. Conclusion: Investigators use a variety of strategies to manage ethical issues in the conduct of end-oflife research. They advise IRBs to seek out expertise, enhance knowledge of the population, and work collaboratively with investigators. Future research will focus on gathering systematic data regarding the experiences of dying patients and their families with end-of-life research

A new parenting-based group intervention for young anxious children: results of a randomized controlled trial

Objective Despite recent advances, there are still no interventions that have been developed for the specific treatment of young children who have anxiety disorders. This study examined the impact of a new, cognitive–behaviorally based parenting intervention on anxiety symptoms. Method Families of 74 anxious children (aged 9 years or less) took part in a randomized controlled trial, which compared the new 10-session, group-format intervention with a wait-list control condition. Outcome measures included blinded diagnostic interview and self-reports from parents and children. Results Intention-to-treat analyses indicated that children whose parent(s) received the intervention were significantly less anxious at the end of the study than those in the control condition. Specifically, 57% of those receiving the new intervention were free of their primary disorder, compared with 15% in the control condition. Moreover, 32% of treated children were free of any anxiety diagnosis at the end of the treatment period, compared with 6% of those in the control group. Treatment gains were maintained at 12-month follow-up. Conclusions This new parenting-based intervention may represent an advance in the treatment of this previously neglected group. Clinical trial registration information: Anxiety in Young Children: A Randomized Controlled Trial of a New Cognitive-Behaviourally Based Parenting Intervention; http://www.isrctn.org/; ISRCTN12166762

A New Approach to In-situ K-Ar Geochronology

The development of an in-situ geochronology capability for Mars and other planetary surfaces has the potential to fundamentally change our understanding of the evolution of terrestrial bodies in the Solar System. For Mars specifically, many of our most basic scientific questions about the geologic history of the planet require knowledge of the absolute time at which an event or process took place on its surface. For instance, what was the age and rate of early Martian climate change recorded in the mineralogy and morphology of surface lithologies (e.g., [1])? In-situ ages from a few select locations within the globally established stratigraphy of Mars would be transformative, enabling us to place direct chronologic constraints on the timing and rates of impact, volcanic, sedimentary, and aqueous processes on the Martian surface

BGS GeoSure 5 km Hex Grids

An introduction to the new Open Government Licence BGS 5km Hex Grid datasets, demonstrating their aesthetic appeal and informational versatility through illustrating three levels of GeoSure Shrink-Swell susceptibility in relation to population density across Great Britain, in 3D

(Fluoro)quinolones and quinolone resistance genes in the aquatic environment: a river catchment perspective.

This study provides an insight into the prevalence of (fluoro)quinolones (FQs) and their specific quinolone qnrS resistance gene in the Avon river catchment area receiving treated wastewater from 5 wastewater treatment plants (WWTPs), serving 1.5 million people and accounting for 75% of inhabitants living in the catchment area in the South West of England. Ofloxacin, ciprofloxacin, nalidixic acid and norfloxacin were found to be ubiquitous with daily loads reaching a few hundred g/day in wastewater influent and tens of g/day in receiving waters. This was in contrast to other FQs analysed: flumequine, nadifloxacin, lomefloxacin, ulifloxacin, prulifloxacin, besifloxacin and moxifloxacin, which were hardly quantified. Enantiomeric profiling revealed that ofloxacin was enriched with the S-(−)-enantiomer, likely deriving from its prescription as the more potent enantiomerically pure levofloxacin, alongside racemic ofloxacin. While ofloxacin's enantiomeric fraction (EF) remained constant, high stereoselectivity was observed in the case of its metabolite ofloxacin-N-oxide. The removal efficiency of quinolones during wastewater treatment at 5 WWTPs utilising either trickling filters (TF) or activated sludge (AS), was compound and wastewater treatment process dependent, with AS providing better efficiency than TF. The qnrS resistance gene was ubiquitous in wastewater. Its removal was WWTP treatment process dependent with TF performing best and resulting in significant removal of the gene (from 28 to 75%). AS underperformed with only 9% removal in the case of activated sludge and actual increase in the gene copy number within sequencing batch reactors (SBRs). Interestingly, the data suggests that higher removal of antibiotics could be linked with high prevalence of the gene (SBR and WWTP E) and vice versa, low removal of antibiotic is correlated with lower prevalence of the gene in wastewater effluent (TF, WWTP B and D). This is especially prominent in the case of ofloxacin and could indicate that AS might be facilitating antimicrobial resistance (AMR) prevalence to higher extent than TF. Wastewater-based epidemiology (WBE) was also applied to monitor any potential misuse (e.g. direct disposal) of FQs in the catchment. In most cases higher use of antibiotics with respect to official statistics (i.e. ciprofloxacin, ofloxacin) was observed, which suggests that FQs management practice require further attention

The effects of verbal information and approach-avoidance training on children's fear-related responses.

BACKGROUND AND OBJECTIVES This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. METHODS One hundred and sixty children (7-11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). RESULTS Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. LIMITATIONS This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. CONCLUSIONS The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear

Tracking the Development of Muscular Myoglobin Stores in Mysticete Calves

For marine mammals, the ability to tolerate apnea and make extended dives is a defining adaptive trait, facilitating the exploitation of marine food resources. Elevated levels of myoglobin within the muscles are a consistent hallmark of this trait, allowing oxygen collected at the surface to be stored in the muscles and subsequently used to support extended dives. In mysticetes, the largest of marine predators, details on muscular myoglobin levels are limited. The developmental trajectory of muscular myoglobin stores has yet to be documented and any physiological links between early behavior and the development of muscular myoglobin stores remain unknown. In this study, we used muscle tissue samples from stranded mysticetes to investigate these issues. Samples from three different age cohorts and three species of mysticetes were included (total sample size = 18). Results indicate that in mysticete calves, muscle myoglobin stores comprise only a small percentage (17–23%) of conspecific adult myoglobin complements. Development of elevated myoglobin levels is protracted over the course of extended maturation in mysticetes. Additionally, comparisons of myoglobin levels between and within muscles, along with details of interspecific differences in rates of accumulation of myoglobin in very young mysticetes, suggest that levels of exercise may influence the rate of development of myoglobin stores in young mysticetes. This new information infers a close interplay between the physiology, ontogeny and early life history of young mysticetes and provides new insight into the pressures that may shape adaptive strategies in migratory mysticetes. Furthermore, the study highlights the vulnerability of specific age cohorts to impending changes in the availability of foraging habitat and marine resources

Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: an embedded randomized controlled trial. Study within a trial (SWAT) protocol

Background Parent-report questionnaires are a common method of generating data on child outcomes in mental health studies. A second report from another person who knows the child (co-respondent) is implemented to reduce bias and increase objectivity. The success of this approach is dependent on the engagement of co-respondents, which can be difficult. Financial incentives are used to increase data return in clinical trials, and to promote referral rates in online marketing. This protocol describes the use of an embedded randomised controlled trial (RCT) to investigate the effect of financial incentives on rates of co-respondent data completion. In the host RCT (of an online intervention designed to reduce the impact of a parent's anxiety on their child) index participants (i.e. parents) are asked to invite a co-respondent to complete measures on the index child. This study will test the hypothesis that providing monetary incentives to index participants will increase the outcome measure completion rate of co-respondents. Methods Embedded RCT of two parallel groups. Participants in the intervention arm will be sent a £10 voucher if their chosen co-respondent completes online baseline measures. Participants in the control arm will not be offered payment regardless of their chosen co-respondent's behaviour. 1754 participants will take part. Analysis will compare co-respondent outcome measure completion rates between the two arms at baseline and follow-up. Conclusion Findings from this study will provide evidence on the impact of offering payment to index participants on return rates of co-respondent data. This will inform resource allocation within future clinical trials