Shared Governance and It\u27s Role in Higher Education

For approximately the past seventy-five years, shared governance has been the overriding principle that guides decision-making in American Colleges and universities. The core notion of shared governance is that both faculty and administrators have important roles to play in setting university policy. Recently, has shared governance merely become a catchphrase that has radically different meanings to different people? This interactive workshop will provide attendees with the tools to fully understand the roles and responsibilities that both faculty and administrators must play to foster a shared governance on their campus

Variation between Point-of-Care and Laboratory HbA1cTesting in Clinical Practice

Aims: The aim of this study was to identify potential disparities between Point-Of-Care Testing (POCT) and laboratory hemoglobinH bA1c reporting at a Federally Qualified Health Center (FQHC).Methods: The electronic medical record was reviewed to identify POCT HbA1c done at a FQHC and centralized laboratory HbA1c performed on the same day. Manual data extraction was used to identify potential variables that could account for disparities between POCT and laboratory testing.Results: A total of 42 samples in 40 patients were identified. The median HbA1c difference was 1.5mmol/mol (0.15%) and ranged from -26-52 mmol/mol (-2.4 to 4.8%). Of the patients in the study, two had underlying co morbidities that could affect the POCT HbA1c.Conclusion: Point-of-care HbA1c testing should not be used in solidarity to diagnosis pre-diabetes and diabetes. When using HbA1c results to guide therapy, self-monitoring of blood glucose and symptoms of both hypo- and hyperglycemia should be correlated to help determine appropriate therapy

Palliative approach in acute neurological events: a five-year study

Introduction: Acute neurological illness often results in severe disability. Five-year life expectancy is around 40%; half the survivors become completely dependent on outside help. Objective: Evaluate the symptoms of patients admitted to a Hospital ward with a diagnosis of stroke, subarachnoid hemorrhage or subdural hematoma, and analyze the role of an In-Hospital Palliative Care Support Team. Material and methods: Retrospective, observational study with a sample consisting of all patients admitted with acute neurological illness and with a guidance request made to the In-Hospital Palliative Care Support Team of a tertiary Hospital, over 5 years (2012-2016). Results: A total of 66 patients were evaluated, with an age median of 83 years old. Amongst them, there were 41 ischaemic strokes, 12 intracranial bleedings, 12 subdural hematomas, and 5 subarachnoid hemorrhages. The median of delay between admission and guidance request was 14 days. On the first evaluation by the team, the GCS score median was 6/15 and the Palliative Performance Scale (PPS) median 10%. Dysphagia (96.8%) and bronchorrhea (48.4%) were the most prevalent symptoms. A total of 56 patients had a feeding tube (84.8%), 33 had vital sign monitoring (50.0%), 24 were hypocoagulated (36.3%), 25 lacked opioid or anti-muscarinic therapy for symptom control (37,9%); 6 patients retained orotracheal intubation, which was removed. In-hospital mortality was 72.7% (n=48). Discussion and conclusion: Patients were severely debilitated, in many cases futile interventions persisted, yet several were under-medicated for symptom control. The delay between admission and collaboration request was high. Due to the high morbidity associated with acute neurological illness, palliative care should always be timely provided.INTRODUÇÃO: Eventos neurológicos agudos resultam frequentemente em incapacidade grave que impede o doente de participar ativamente nas decisões do seu próprio tratamento. A sobrevida a cinco anos ronda os 40%; metade dos sobreviventes fica dependente de terceiros. Objetivo: Avaliar a sintomatologia de doentes internados com acidente vascular cerebral (AVC), hemorragia subarcnoideia (HSA) ou subdural (HSD) e analisar a intervenção de uma Equipe Intra-Hospitalar de Suporte em Cuidados Paliativos (EIHSCP). MATERIAL E MÉTODOS: Estudo retrospetivo observacional dos doentes com diagnóstico principal de evento neurológico agudo com pedido de colaboração à EIHSCP, num hospital terciário, durante cinco anos (2012-2016). RESULTADOS: Avaliados 66 doentes, com média de idade de 83 anos. Destacam-se 41 AVC isquêmicos, 12 hemorrágicos, 12 HSD e 5 HSA. A média da demora entre internamento e pedido de colaboração à EIHSCP foi de 14 dias. Na primeira observação, a média na escala de coma de Glasgow foi de 6/15 e na Palliative Performance Scale (PPS) foi de 10%. Disfagia (96,8%) e broncorreia (48,4%) foram os sintomas mais frequentes. A maioria dos doentes (56/66) mantinha sonda nasogástrica (84,8%); 33 encontravam-se em monitorização cardiorrespiratória (50,0%); 24 estavam sob hipocoagulação (36,3%); 25 necessitavam de opioide e antimuscarínico que não estavam prescritos (37,9%); seis tinham tubo orotraqueal, que foi retirado. A mortalidade intra-hospitalar foi de 72,7% (n=48). DISCUSSÃO E CONCLUSÃO: Destaca-se o estado debilitado dos doentes; em muitos casos, intervenções fúteis persistiam, mas várias foram submedicadas para o controle dos sintomas. Verificou-se um tempo de espera elevado até o pedido de colaboração. Pela elevada morbilidade associada a esses eventos, cuidados paliativos diferenciados deveriam ser oferecidos no tempo adequadoinfo:eu-repo/semantics/publishedVersio

Campus Incivility and Free Speech: A Contemporary Dilemma

The issue of free speech on college campuses is as old as education itself and as current as today\u27s news. Institutions of higher education often find themselves torn between their desire to create environments where students and professors remain physically safe and their mission to protect academic freedom and the right of free speech. This interactive presentation will provide academic leaders with the skill set to increase the likelihood that constructive conflicts between ideas don\u27t escalate into destructive, violent acts

INCENTIVE AND ACCURACY ISSUES IN MOVIE PREDICTION MARKETS

We compare the forecasts of nineteen movie box office results from real money (Iowa Electronic Market) and play money (Hollywood Stock Exchange) prediction markets. The forecasts were not significantly different, contrary to recent research on incentives and prediction market accuracy. Proponents of play money incentives suggest that (play) wealth concentrates in the hands of knowledgeable traders over time. This should lead to improved accuracy over time. A longitudinal analysis of results (1999-2002) from the play money Hollywood Stock Exchange fails to find significant improvement over time. This may be due to an increased number of less knowledgeable traders who, nevertheless, provide liquidity in the market

Predicting Joint Replacement Waiting Times

Currently, the median waiting time for total hip and knee replacement in Ontario is greater than 6 months. Waiting longer than 6 months is not recommended and may result in lower post-operative benefits. We developed a simulation model to estimate the proportion of patients who would receive surgery within the recommended waiting time for surgery over a 10-year period considering a wide range of demand projections and varying the number of available surgeries. Using an estimate that demand will grow by approximately 8.7% each year for 10 years, we determined that increasing available supply by 10% each year was unable to maintain the status quo for 10 years. Reducing waiting times within 10 years required that the annual supply of surgeries increased by 12% or greater. Allocating surgeries across regions in proportion to each region’s waiting time resulted in a more efficient distribution of surgeries and a greater reduction in waiting times in the long-term compared to allocation strategies based only on the region’s population size

Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer’s disease

Background: Accurate and timely diagnosis of Alzheimer’s disease (AD) is important for prompt initiation of treatment in patients with AD and to avoid inappropriate treatment of patients with false-positive diagnoses. Methods: Using a Markov model, we estimated the lifetime costs and quality-adjusted life-years (QALYs) of cerebrospinal fluid biomarker analysis in a cohort of patients referred to a neurologist or memory clinic with suspected AD who remained without a definitive diagnosis of AD or another condition after neuroimaging. Parametric values were estimated from previous health economic models and the medical literature. Extensive deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. Results: At a 12.7% pretest probability of AD, biomarker analysis after normal neuroimaging findings has an incremental cost-effectiveness ratio (ICER) of $11,032 per QALY gained. Results were sensitive to the pretest prevalence of AD, and the ICER increased to over$50,000 per QALY when the prevalence of AD fell below 9%. Results were also sensitive to patient age (biomarkers are less cost-effective in older cohorts), treatment uptake and adherence, biomarker test characteristics, and the degree to which patients with suspected AD who do not have AD benefit from AD treatment when they are falsely diagnosed. Conclusions: The cost-effectiveness of biomarker analysis depends critically on the prevalence of AD in the tested population. In general practice, where the prevalence of AD after clinical assessment and normal neuroimaging findings may be low, biomarker analysis is unlikely to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY gained. However, when at least 1 in 11 patients has AD after normal neuroimaging findings, biomarker analysis is likely cost-effective. Specifically, for patients referred to memory clinics with memory impairment who do not present neuroimaging evidence of medial temporal lobe atrophy, pretest prevalence of AD may exceed 15%. Biomarker analysis is a potentially cost-saving diagnostic method and should be considered for adoption in high-prevalence centers

Managing multiple pressures for cetaceans’ conservation with an Ecosystem-Based Marine Spatial Planning approach

Despite the recognized important ecological role that cetaceans play in the marine environment, their protection is still scarcely enforced in the Mediterranean Sea even though this area is strongly threatened by local human pressures and climate change. The piecemeal of knowledge related to cetaceans' ecology and distribution in the basin undermines the capacity of addressing cetaceans' protection and identifying effective conservation strategies. In this study, an Ecosystem-Based Marine Spatial Planning (EB-MSP) approach is applied to assess human pressures on cetaceans and guide the designation of a conservation area in the Gulf of Taranto, Northern Ionian Sea (Central-eastern Mediterranean Sea). The Gulf of Taranto hosts different cetacean species that accomplish important phases of their life in the area. Despite this fact, the gulf does not fall within any area-based management tools (ABMTs) for cetacean conservation. We pin down the Gulf of Taranto being eligible for the designation of diverse ABMTs for conservation, both legally and non-legally binding. Through a risk-based approach, this study explores the cause-effect relationships that link any human activities and pressures exerted in the study area to potential effects on cetaceans, by identifying major drivers of potential impacts. These were found to be underwater noise, marine litter, ship collision, and competition and disturbance on preys. We draw some recommendations based on different sources of available knowledge produced so far in the area (i.e., empirical evidence, scientific and grey literature, and expert judgement) to boost cetaceans’ conservation. Finally, we stress the need of sectoral coordination for the management of human activities by applying an EB-MSP approach and valuing the establishment of an ABMT in the Gulf of Taranto

An Evaluation of Strategies to Reduce Waiting Times for Total Joint Replacement in Ontario

Background: In 2005, the median waiting time for total hip and knee joint replacements in Ontario was greater than 6 months, which is considered longer than clinically appropriate. Demand is expected to increase and exacerbate already long waiting times. Solutions are needed to reduce waiting times and improve waiting list management. Methods: We developed a discrete event simulation model of the Ontario total joint replacement system to evaluate the effects of 4 management strategies on waiting times: (1) reductions in surgical demand; (2) formal clinical prioritization; (3) waiting time guarantees; and (4) common waiting list management. Results: If the number of surgeries performed increases by less than 10% each year, then demand must be reduced by at least 15% to ensure that, within 10 years, 90% of patients receive surgery within their maximum recommended waiting time. Clinically prioritizing patients reduced waiting times for high-priority patients and increased the number of patients at all priority levels who received surgery each year within recommended maximum waiting times by 9.3%. A waiting time guarantee for all patients provided fewer surgeries within recommended waiting times. Common waiting list management improved efficiency and increased equity in waiting across regions. Discussion: Dramatically increasing the supply of joint replacement surgeries or diverting demand for surgeries to other jurisdictions will reduce waiting times for total joint replacement surgery. Introducing a strictly adhered to patient prioritization scheme will ensure that more patients receive surgery within severity-specific waiting time targets. Implementing a waiting time guarantee for all patients will not reduce waiting times—it will only shuffle waiting times from some patients to others. To reduce waiting times to clinically acceptable levels within 10 years, increases in the number of surgeries provided greater than those observed historically or reductions in demand are needed

Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer\u27s disease

Background: Accurate and timely diagnosis of Alzheimer\u27s disease (AD) is important for prompt initiation of treatment in patients with AD and to avoid inappropriate treatment of patients with false-positive diagnoses. Methods: Using a Markov model, we estimated the lifetime costs and quality-adjusted life-years (QALYs) of cerebrospinal fluid biomarker analysis in a cohort of patients referred to a neurologist or memory clinic with suspected AD who remained without a definitive diagnosis of AD or another condition after neuroimaging. Parametric values were estimated from previous health economic models and the medical literature. Extensive deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. Results: At a 12.7% pretest probability of AD, biomarker analysis after normal neuroimaging findings has an incremental cost-effectiveness ratio (ICER) of $11,032 per QALY gained. Results were sensitive to the pretest prevalence of AD, and the ICER increased to over$ 50,000 per QALY when the prevalence of AD fell below 9%. Results were also sensitive to patient age (biomarkers are less cost-effective in older cohorts), treatment uptake and adherence, biomarker test characteristics, and the degree to which patients with suspected AD who do not have AD benefit from AD treatment when they are falsely diagnosed. Conclusions: The cost-effectiveness of biomarker analysis depends critically on the prevalence of AD in the tested population. In general practice, where the prevalence of AD after clinical assessment and normal neuroimaging findings may be low, biomarker analysis is unlikely to be cost-effective at a willingness-to-pay threshold of $ 50,000 per QALY gained. However, when at least 1 in 11 patients has AD after normal neuroimaging findings, biomarker analysis is likely cost-effective. Specifically, for patients referred to memory clinics with memory impairment who do not present neuroimaging evidence of medial temporal lobe atrophy, pretest prevalence of AD may exceed 15%. Biomarker analysis is a potentially cost-saving diagnostic method and should be considered for adoption in high-prevalence centers