Mutually assured construction : resurrecting the West Texas missile silos

A group of enthusiasts near Abilene, Texas are turning decommissioned, Cold War-era nuclear missile silos into homes, doomsday shelters, historical monuments and businesses, offering a unique glimpse into the blue-collar, do-it-yourself psyche of a region of Texas forged during the Cold War.Journalis

Florida: the east coast and Keys.

A mix of text and photographs illustrating recreational opportunities as well as agriculture products in Florida. Also contains several pictures of major hotels of the East Coast Hotel System.https://stars.library.ucf.edu/floridaheritage/1139/thumbnail.jp

Intramuscular lipid oxidation and obesity

There is an accumulating amount of evidence indicating that lipid oxidation is depressed in the skeletal muscle of obese individuals. Decrements in fatty acid oxidation (FAO) have been reported with obesity in models ranging from whole body measurements to isolated skeletal muscle preparations as well as in myotubes raised in culture. This reduction appears to be associated with a depression in the activities of enzymes involved in various steps of lipid oxidation, which subsequently partitions lipid entering the cell toward storage. The defect in FAO in skeletal muscle may be critical in relation to health, as a reduction in the capacity for lipid oxidation could directly or indirectly contribute to the insulin resistance commonly evident with obesity. Although less characterized, a decrement in FAO has also been linked with weight gain, which suggests that this characteristic may be an integral aspect leading to the obese state. In terms of intervention, weight loss does not seem to correct the defect in FAO with obesity. This review will provide evidence supporting a reduction in muscle FAO with obesity. Originally published AJP - Regulatory, Integrative and Comparative Physiology 294(4) 2009

Creating Cherokee Print:

The 1821 creation of a written syllabary for the Cherokee language by Sequoyah and its use in the Nation’s newspaper, the Cherokee Phoenix, are routinely examined within the context of the tribe’s discourse surrounding removal in the 1830s, but scholars often overlook the influence of the missionary Samuel Austin Worcester and the American Board of Commissioners for Foreign Missions (ABCFM) in shaping the parameters of that discourse by arranging the syllabary, typesetting the characters, and establishing the press. This article illuminates these significant historical and technical aspects of Worcester’s influence on the creation of Cherokee print. Worcester’s influence on the Cherokee syllabary is important, given the enduring nature of his influence and the rapid adoption of the written language: within fourteen years of its introduction, and seven years of the first printing, more than half of all households in the Cherokee Nation had a reader of Cherokee. Today, nearly 180 years after Worcester first standardized Cherokee characters in print, his forms of the syllabic characters guide instruction in reading and writing Cherokee, and his translation of the Bible into Cherokee persists in Cherokee homes

Rounding frequency and hospital length of stay for children with respiratory illnesses: A simulation study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102158/1/jhm2097.pd

Consistently Using a Transportation Department for Patient Discharge to Sustain Nursing Staffing Levels

IMPROVING PATIENT FLOW BY UTILIZING A HOSPITAL TRANSPORTATION DEPARTMENT FOR DISCHARGES Using a transportation department for transporting patients for discharge is the industry standard. At a large urban hospital, inconsistent use of this department has resulted in frontline caregivers (RNs) having to pick up this function, resulting in potentially unsafe staffing levels on the floor. The goal of this quality improvement project was to improve the percent of discharges with the transport department from ≤10% to 70% by the end is fiscal year 2018 in an academic tertiary medical center. Baseline metrics demonstrated the current state and a root cause of analysis were initiated. As a result of this analysis, it was established that staff did not understand the best practice for transporting patients for discharge. A number of KPIs were developed for the utilization of the department for patient discharge. Post Kaizen pilot implementation, teletracking metrics demonstrated improvements in utilization. Next step is to rollout to all units and monthly reinforcement with continuous educational/data support from transport, access/flow and operational excellence

Substrate utilization during submaximal exercise in children with a severely obese parent

Background We have reported a reduction in fatty acid oxidation (FAO) at the whole-body level and in skeletal muscle in severely obese (BMI ≥ 40 kg/m2) individuals; this defect is retained in cell culture suggesting an inherent component. The purpose of the current study was to determine if an impairment in whole-body fatty acid oxidation (FAO) was also evident in children with a severely obese parent. Methods Substrate utilization during submaximal exercise (cycle ergometer) was determined in children ages 8–12 y with a severely obese parent (OP, n = 13) or two lean/non-obese (BMI range of 18 to 28 kg/m2) parents (LP, n = 13). A subgroup of subjects (n = 3/group) performed 4 weeks of exercise training with substrate utilization measured after the intervention. Results The children did not differ in age (LP vs. OP, respectively) (10.7 ± 0.5 vs. 10.2 ± 0.5 y), BMI percentile (65.3 ± 5.2 vs. 75.9 ± 7), Tanner Stage (1.4 ± 0.2 vs. 1.5 ± 0.2), VO2peak (40.3 ± 2.7 vs. 35.6 ± 2.6 ml/kg/min) or physical activity levels (accelerometer). At the same absolute workload of 15 W (~38% VO2peak), RER was significantly (P ≤ 0.05) lower in LP vs. OP (0.83 ± 0.02 vs. 0.87 ± 0.01) which was reflected in a reduced reliance on FAO for energy production in the OP group (58.6 ± 5.1 vs. 43.1 ± 4.0% of energy needs during exercise from FAO). At a higher exercise intensity (~65% VO2peak) there were no differences in substrate utilization between LP and OP. After exercise training RER tended to decrease (P = 0.06) at the 15 W workload, suggesting an increased reliance on FAO regardless of group. Conclusions These findings suggest that the decrement in FAO with severe obesity has an inherent component that may be overcome with exercise training

Improving Patient Flow by Increasing Early Discharges on a Mother & Baby Unit

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities. A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff. Data collection post countermeasure implementation demonstrated some early improvements morning discharges. Next steps include regular review of KPI goals and progress and their impact on project goals

Correlation of the NBME Advanced Clinical Examination in EM and the National EM M4 exams

Introduction Since 2011 two online, validated exams for fourth-year emergency medicine (EM) students have been available (National EM M4 Exams). In 2013 the National Board of Medical Examiners offered the Advanced Clinical Examination in Emergency Medicine (EM-ACE). All of these exams are now in widespread use; however, there are no data on how they correlate. This study evaluated the correlation between the EM-ACE exam and the National EM M4 Exams. Methods From May 2013 to April 2014 the EM-ACE and one version of the EM M4 exam were administered sequentially to fourth-year EM students at five U.S. medical schools. Data collected included institution, gross and scaled scores and version of the EM M4 exam. We performed Pearson’s correlation and random effects linear regression. Results 303 students took the EM-ACE and versions 1 (V1) or 2 (V2) of the EM M4 exams (279 and 24, respectively). The mean percent correct for the exams were as follows: EM-ACE 74.8 (SD-8.83), V1 83.0 (SD-6.41), V2 78.5 (SD-7.70). Pearson’s correlation coefficient for the V1/EM-ACE was 0.51 (0.42 scaled) and for the V2/EM-ACE was 0.59 (0.41 scaled). The coefficient of determination for V1/EM-ACE was 0.72 and for V2/EM-ACE = 0.71 (0.86 and 0.49 for scaled scores). The R-squared values were 0.25 and 0.30 (0.18 and 0.13, scaled), respectively. There was significant cluster effect by institution. Conclusion There was moderate positive correlation of student scores on the EM-ACE exam and the National EM M4 Exams

Improving Safe Handoffs & Transitions from the ED to Adult Inpatient: A Response to the AHRQ Hospital Patient Safety Culture Survey

SAFE TRANSITIONS AND PATIENT HANDOFFS IN A LARGE ACUTE CARE HOSPITAL It is well documented in the literature that ineffective patient handoffs and transitions continues to be an area that can lead to adverse patient safety events so it is an urgent opportunity for a performance improvement plan. At an academic tertiary care medical center, the lowest scoring domain from the FY2017 AHRQ Patient Safety Culture Survey was patient handoffs and transitions. A team was established consisting of staff from the Emergency Department and a medical/surgical unit to develop a plan for implementing improvement interventions. Their goal was to attain a ≥ 5% improvement on the patient handoff and transitions question in the Survey by the end of 12/30/2018. A root cause analysis was initiated and resulted in a KPI being developed to collect baseline data on handoffs and transitions between the two units. After three phases to analyze and improve, several countermeasures were created. Amongst them was the development of a evidence based mnemonic handoff tool to be used within 30 minutes of patient transfer. Pulse surveys of the involved units conducted at various intervals demonstrated significant improvement of \u3e5% in the 3 teamwork questions. Next steps will be to standardize, sustain and spread the improvement methods