Initiation and dynamics of a spiral wave around an ionic heterogeneity in a model for human cardiac tissue

In relation to cardiac arrhythmias, heterogeneity of cardiac tissue is one of the most important factors underlying the onset of spiral waves and determining their type. In this paper, we numerically model heterogeneity of realistic size and value and study formation and dynamics of spiral waves around such heterogeneity. We find that the only sustained pattern obtained is a single spiral wave anchored around the heterogeneity. Dynamics of an anchored spiral wave depend on the extent of heterogeneity, and for certain heterogeneity size, we find abrupt regional increase in the period of excitation occurring as a bifurcation. We study factors determining spatial distribution of excitation periods of anchored spiral waves and discuss consequences of such dynamics for cardiac arrhythmias and possibilities for experimental testings of our predictions

Global alternans instability and its effect on non-linear wave propagation : dynamical Wenckebach block and self terminating spiral waves

The main mechanism of formation of reentrant cardiac arrhythmias is via formation of waveblocks at heterogeneities of cardiac tissue. We report that heterogeneity and the area of waveblock can extend itself in space and can result formation of new additional sources, or termination of existing sources of arrhythmias. This effect is based on a new form of instability, which we coin as global alternans instability (GAI). GAI is closely related to the so-called (discordant) alternans instability, however its onset is determined by the global properties of the APD-restitution curve and not by its slope. The APD-restitution curve relates the duration of the cardiac pulse (APD) to the time interval between the pulses, and can easily be measured in an experimental or even clinical setting. We formulate the conditions for the onset of GAI, study its manifestation in various 1D and 2D situations and discuss its importance for the onset of cardiac arrhythmias

Introduction of Strong for Surgery Pre-surgical Checklist for Elective Procedures​

Nearly one-third of hospitalized patients experience preventable harm or adverse effects related to the care they received, often due to preventable surgical complications. Thorough preoperative assessment and management of risk factors can lessen this risk. The purpose of this quality improvement project was to increase knowledge and prepare staff for use of the preoperative tool Strong for Surgery (S4S) in a general surgery clinic in a rural hospital in southern Illinois. Support for each of the key components of the Strong for Surgery pre-surgical checklist was reviewed in the literature; these include nutrition, smoking cessation, glycemic control, medication management, safe and effective pain management, prehabilitation, and delirium. The process of staff education began with an in-person introduction to the Strong for Surgery pre-surgical checklist followed by an online computer-based learning module. The learning module encompassed the entirety of the S4S checklist, rationales for use, and methods for implementation. Learning outcomes were measured by comparing scores of identical pre-assessment and post-assessment tests containing multiple choice, true/false, and select all that apply questions. Post-assessment score results of 20 participants increased by 35% compared to pre-assessment. This project provided education on the S4S pre-surgical checklist as the initial step for planned future implementation into the standard of care. The immediate impact was an improvement in knowledge about the checklist and staff roles related to integrating S4S into care. The long-term implications of this project are the potential for improved patient outcomes, such as decreases in mortality, morbidity, reoperation, and length of stay. Education and preparation for the planned implementation of the S4S checklist will lead to a smooth implementation process. Key Words: surgery, quality of care, recovery, Strong for Surgery, ERAS, presurgica

Writing with Parents in Response to Picture Book Read Alouds

High-quality writing instruction needs to permeate elementary students’ in- and outside-of-school experiences. The aim of this research was to explore how teaching writing to parents may support home-school literacy connections. This qualitative case study explored parents’ experiences in interactive writing sessions. The descriptive coding and constant comparative analysis of transcribed parent writing sessions, field notes, and documents revealed three themes: (1) Writing Tips and Strategies, (2) Parent-Writers, and (3) Story Connections. The parent writing sessions facilitated parents’ understanding of how to support their elementary-age children’s writing development. Parents demonstrated a desire to support their children’s writing development, and they needed strategies to understand how to help. Parents applied suggestions as writers to support their children’s writing development at home. Collaborating with the children’s parents helped increase the likelihood the writing strategies gleaned from the writing clinic would be used within the children’s homes