Sketch of the History of Yale University

The following sketch has been compiled to meet the frequent demand, on the part of visitors to New Haven and members of the University, for some brief statement of the earlier history of the institution, which will supplement the accounts of its present condition contained in current annual publications. The aim has been to present the most important facts, accurately and concisely. Sources of further information are indicated in the Appendix. [from the Prefatory Note

Comparing the cumulative pain patients experience waiting for knee arthroplasty to their postoperative pain

Introduction: Reduction of pain is a major goal of anesthesiologists treating patients undergoing knee arthroplasty. This has been achieved traditionally through the use of regional analgesia. Although these techniques decrease postoperative pain, they inherently do not affect the longstanding pain patients experience as they wait for surgery. Our objectives were to quantify: 1) the decrease in pain achieved by surgical joint replacement; and 2) the decrease in postoperative pain achievable through femoral nerve blocks versus opioids. From a systems-based perspective, we wanted to determine how much reduction in waiting time before surgery would be necessary to achieve an equal cumulative pain decrease (i.e, pain x duration of pain) as that afforded by regional techniques in the immediate postoperative period. Materials and methods: A systematic review using PubMed was performed to obtain: 1) articles reporting preoperative pain scores for patients awaiting joint arthroplasty; 2) articles with knee arthroplasty patients who received femoral nerve blocks; and 3) articles providing duration on joint arthroplasty waiting lists. Cumulative pain was assessed by the area under the response curve of pain scores vs. time, a methodology that is simple and valid. This was calculated by multiplying mean pain scores by the duration of pain. Results: The decrease in knee pain subsequent to arthroplasty (6.4/10 vs. 2.9/10) is similar to the decrease in pain afforded by femoral nerve blocks for knee arthroplasty (4.7/10 vs. 2.0/10). Waiting times in many countries exceed 3 months. A decrease in waiting time by about 2 days results in a decrease in the area under the curve of Conclusion: Reducing waiting time for knee arthroplasty decreases total pain experienced by patients and is one systems-based approach that anesthesiologists could take to relieve pain. Further studies are needed to evaluate how best to accomplish this goal

Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data

<p>Abstract</p> <p>Background</p> <p>No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach.</p> <p>Methods</p> <p>A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered.</p> <p>Results</p> <p>Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments.</p> <p>Conclusions</p> <p>Our technical advance is the development and use of automated event-based knowledge elicitation to identify suboptimal OR management decisions that decrease the efficiency of use of OR time. The adapted scenarios can be used in future decision-making.</p

Filtration–UV irradiation as an option for mitigating the risk of microbiologically influenced corrosion of subsea construction alloys in seawater

The effect of filtration-UV irradiation of seawater on the biofilm activity on several offshore structural alloys was evaluated in a continuous flow system over 90 days. Biofilms ennobled the electrode potential by +400–500 mV within a few days of exposure to raw untreated seawater. Filtration-UV irradiation of the seawater delayed the ennoblement of the steels for up to 40 days and lowered localized corrosion rates in susceptible alloys. Ennobling biofilms were composed of microbial cells, diatoms and extracellular polymeric substances and the bacterial community in biofilms was affected by both the alloy composition and seawater treatment

Healthy lifestyle interventions to combat noncommunicable disease : a novel nonhierarchical connectivity model for key stakeholders : a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

© 2015 Mayo Foundation for Medical Education and Research, and the European Society of Cardiology. This article is being published concurrently in Mayo Clinic Proceedings [1]. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. [1] Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert M-F, Franklin NC, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D. Healthy Lifestyle Interventions to Combat Noncommunicable Diseased - A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Mayo Clinic Proceedings 2015; DOI: 10.1016/j.mayocp.2015.05.001 [In Press]Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to$13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.info:eu-repo/semantics/publishedVersio

A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome

BACKGROUND: Management of acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS). The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker)? METHODS: The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. RESULTS: Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be$62,238 (5% – 95% percentiles $42,259 –$83,766), with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost$267 more) hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. CONCLUSION: ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS

Plant diversity patterns in neotropical dry forests and their conservation implications

This is the author accepted manuscript. The final version is available from American Association for the Advancement of Science via the DOI in this record.Seasonally dry tropical forests are distributed across Latin America and the Caribbean and are highly threatened, with less than 10% of their original extent remaining in many countries. Using 835 inventories covering 4660 species of woody plants, we show marked floristic turnover among inventories and regions, which may be higher than in other neotropical biomes, such as savanna. Such high floristic turnover indicates that numerous conservation areas across many countries will be needed to protect the full diversity of tropical dry forests. Our results provide a scientific framework within which national decision-makers can contextualize the floristic significance of their dry forest at a regional and continental scale.This paper is the result of the Latin American and Caribbean Seasonally Dry Tropical Forest Floristic Network (DRYFLOR), which has been supported at the Royal Botanic Garden Edinburgh by a Leverhulme Trust International Network Grant (IN-074). This work was also supported by the U.K. Natural Environment Research Council grant NE/I028122/1; Colciencias Ph.D. scholarship 529; Synthesys Programme GBTAF-2824; the NSF (NSF 1118340 and 1118369); the Instituto Humboldt (IAvH)–Red colombiana de investigación y monitoreo en bosque seco; the Inter-American Institute for Global Change Research (IAI; Tropi-Dry, CRN2-021, funded by NSF GEO 0452325); Universidad Nacional de Rosario (UNR); and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). The data reported in this paper are available at www.dryflor.info. R.T.P. conceived the study. M.P., A.O.-F., K.B.-R., R.T.P., and J.W. designed the DRYFLOR database system. K.B.-R. and K.G.D. carried out most analyses. K.B.-R. R.T.P., and K.G.D. wrote the manuscript with substantial input from A.D.-S., R.L.-P., A.O.-F., D.P., C.Q., and R.R. All the authors contributed data, discussed further analyses, and commented on various versions of the manuscript. K.B.-R. thanks G. Galeano who introduced her to dry forest research. We thank J. L. Marcelo, I. Huamantupa, C. Reynel, S. Palacios, and A. Daza for help with fieldwork and data entry in Peru

Sketch of the Life and Writings of John Davenport

SOME three or four years ago, I was invited to prepare for this Society a list of the writings of the founders of the New Haven Colony, John Davenport and Theophilus Eaton, with the understanding that if material throwing new light on their characters should be found, the Rev. Dr. Bacon would sum up the results. In fulfilling, in part, my share of the undertaking, I find at the outset this embarrassment, that if I limit myself to the mere titles and dates of Davenport\u27s writings, nothing can excuse the tediousness of the enumeration: on the other hand, I am precluded from encroaching on the province of another paper which is to follow. I shall endeavor to confine myself to a chronological outline of facts, with such explanations as are needed at the distance of two centuries; and I am well aware that the bare outline may disappoint, both those whose lack of knowledge will lead them to expect too much, and those who know the story already, and who know that interesting material cannot be manufactured to order. Depositor\u27s note: This is still the most complete published biography of John Davenport (1597-1670); it runs 29 pages, plus a bibliography of his works