Discordant Cardiopulmonary Resuscitation at an Academic Midwest Medical Center- Prevalence and Solutions

BACKGROUND: Code status orders are important features of patient-centered clinical decisions, patient autonomy, and end-of-life care. Despite proper documentation of “do not resuscitate” (DNR) code status, hospitalized patients may be subjected to cardiopulmonary resuscitation (CPR) efforts that go against their wishes. PURPOSE: The objective of this study was to identify and describe the population of hospitalized patients receiving discordant resuscitation efforts at a Midwest academic medical center utilizing electronic health records (EHR). METHODS: The study included EHR records between 01/01/2011 and 01/01/2021 for hospitalized patients 19 years and older who experienced cardiac arrest (ICD-10 I46) and were documented as DNR. Patients younger than 19 years of age and those with full code status were excluded. EPIC’s “code narrator” was queried for records meeting the inclusion criteria. Using the code start and stop time along with the timestamp of their code status order, patients who were DNR at the time of the code start time were included, and all others were excluded. RESULTS: Thirteen of 112 (11.6%) of DNR patients who experienced cardiac arrest had CPR performed, with two patients experiencing discordant resuscitation twice. Patients who experienced resuscitation efforts discordant with their code status were 53.8% female and 84.6% White, with a median age of 82 years old (47-94). Median code duration was 16.9 minutes (1.7-50.9) with 9.89 minutes (5-50.9) of chest compressions. Average length of code status prior to code start time was 1.66 days. Seven of 15 (46.7%) CPR events resulted in return of spontaneous circulation (ROSC). CONCLUSIONS: Discordant in-hospital resuscitation efforts contribute to significant patient harm and moral distress Thirteen unique patients whose resuscitation wishes were not followed were identified. Long term goals of this project are to investigate possible causes of these events and develop solutions

Temporal Course of the Tourette Syndrome Clinical Triad

Background: Tourette syndrome (TS) is a disorder characterized by childhood onset of motor and phonic tics, often with improvement of tic symptoms by young adult years. The temporal course of tics and commonly comorbid behavioral symptoms is still not well characterized. Methods: In order to clarify the time course of tics and comorbid attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD) in TS, we administered a brief survey regarding the course of symptoms at a single point in time to 53 TS patients aged 13–31 years. Results: Mean age (±SD) at symptom onset was 7.9 (±3.6) years for tics, 7.9 (±3.5) for ADHD, and 9.2 (±5.0) for OCD. Age at peak symptom severity was 12.3 (±4.6) years for tics, 10.8 (±3.8) for ADHD, and 12.6 (±5.5) for OCD. Tics, ADHD, and OCD were reported to be no longer present in 32.0%, 22.8%, and 21.0% of subjects, respectively. Decline in symptom severity began at age 14.7 (±3.7) years for tics, 13.9 (±2.9) for ADHD, and 15.1 (±5.0) for OCD. Remission of symptoms occurred at age 17.4 (±3.8) years for tics, 17.4 (±1.3) for ADHD, and 15.6 (±2.3) for OCD. Discussion: Our data confirm and expand previously reported TS spectrum symptom milestones and may guide design of future research aimed at improving the course of TS. Keywords: Tourette, obsessive compulsive disorder, attention deficit hyperactivity disorder, tic Citation: Shprecher DR, Rubenstein LA, Gannon K, et al. Temporal course of the Tourette syndrome clinical triad. Tremor Other Hyperkinet Mov. 2014; 4. doi: 10.7916/D8HD7SV

Investigating the Information Systems Heterarchy

This article assesses how one IS organization is changing in response to the increased globalization of software development and posits the emergence of a new form of multi-national enterprise (MNE)—the heterarchy. Data from two projects create new insights into the structures and behaviors of ISMNEs as they adapt to global systems development. The article identifies four primary dimensions of impact—cultural, economic, operational, and organizational—and suggests how such organizations are evolvin

The Grizzly, March 23, 1979

Decision is not up to Students: Council Mailroom Recommendations Disregarded • Meistersingers Return From Spring Tour • College Dismisses 2 For Theft • The Pervasive Power of ETS • Campus Consumerism • Letters to the Editor: WRUC replies (again); Grizzly applauded • Roving Reporter: Greek life beneficial? • Scotland Calls • Ursinus News In Brief: U.C. grad to attend Olympic academy; Pi Nu Epsilon holds Spring induction; Origin of life forum; Williams wins business award • Summer evening school offerings • Regional Rhythm • Twelfth Night • The Deer Hunter • Bob Welch: Three Hearts A Winner • Muds Capture \u2779 Intramural Title • Tennis Team Hoping to Ace Foeshttps://digitalcommons.ursinus.edu/grizzlynews/1016/thumbnail.jp

pdx-1 function is specifically required in embryonic β cells to generate appropriate numbers of endocrine cell types and maintain glucose homeostasis

AbstractThe pdx1 gene is essential for pancreatic organogenesis in humans and mice; pdx1 mutations have been identified in human diabetic patients. Specific inactivation of pdx1 in adult β cells revealed that this gene is required for maintenance of mature β cell function. In the following study, a Cre-lox strategy was used to remove pdx1 function specifically from embryonic β cells beginning at late-gestation, prior to islet formation. Animals in which pdx1 is lost in insulin-producing cells during embryogenesis had elevated blood glucose levels at birth and were overtly diabetic by weaning. Neonatal and adult mutant islets showed a dramatic reduction in the number of insulin+ cells and an increase in both glucagon+ and somatostatin+ cells. Lineage tracing revealed that excess glucagon+ and somatostatin+ cells did not arise by interconversion of endocrine cell types. Examination of mutant islets revealed a decrease in proliferation of insulin-producing cells just before birth and a concomitant increase in proliferation of glucagon-producing cells. We propose that pdx1 is required for proliferation and function of the β cells generated at late gestation, and that one function of normal β cells is to inhibit the proliferation of other islet cell types, resulting in the appropriate numbers of the different endocrine cell types

Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales:a cohort study

OBJECTIVES: Studies that use national datasets to evaluate the management of older women with breast cancer are often constrained by a lack of information on patient fitness. This study constructed a frailty index for use with secondary care administrative records and evaluated its ability to improve models of treatment patterns and overall survival in women with breast cancer. DESIGN: Retrospective cohort study. PARTICIPANTS: Women aged ≥50 years with oestrogen receptor (ER) positive early invasive breast cancer diagnosed between 2014 and 2017 in England. METHODS: The secondary care administrative records frailty (SCARF) index was based on the cumulative deficit model of frailty, using International Statistical Classification of Diseases, Injuries and Causes of Death, 10th revision codes to define a set of deficits. The index was applied to administrative records that were linked to national cancer registry datasets. The ability of the SCARF index to improve the performance of regression models to explain observed variation in the rate of surgery and overall survival was evaluated using Harrell's c-statistic and decision curve analysis. External validation was performed on a dataset of similar women diagnosed in Wales. RESULTS: The SCARF index captured 32 deficits that cover functional impairment, geriatric syndromes, problems with nutrition, cognition and mood, and medical comorbidities. In the English dataset (n=67 925), the prevalence of frailty in women aged 50-69, 70-79 and ≥80 years was 15%, 28% and 47%, respectively. Adding a frailty measure to regression models containing age, tumour characteristics and comorbidity improved their ability to: (1) discriminate between whether a woman was likely to have surgery and (2) predict overall survival. Similar results were obtained when the models were applied to the Welsh cohort (n=4 230). CONCLUSION: The SCARF index provides a simple and consistent method to identify frailty in population level data and could help describe differences in breast cancer treatments and outcomes

Guidelines of the American Society of Mammalogists for the use of wild mammals in research

Guidelines for use of wild mammal species are updated from the American Society of Mammalogists (ASM) 2007 publication. These revised guidelines cover current professional techniques and regulations involving mammals used in research and teaching. They incorporate additional resources, summaries of procedures, and reporting requirements not contained in earlier publications. Included are details on marking, housing, trapping, and collecting mammals. It is recommended that institutional animal care and use committees (IACUCs), regulatory agencies, and investigators use these guidelines as a resource for protocols involving wild mammals. These guidelines were prepared and approved by the ASM, working with experienced professional veterinarians and IACUCs, whose collective expertise provides a broad and comprehensive understanding of the biology of nondomesticated mammals in their natural environments. The most current version of these guidelines and any subsequent modifications are available at the ASM Animal Care and Use Committee page of the ASM Web site (http://mammalsociety.org/committees/index.asp).American Society of Mammalogist

Spectral Measures and Generating Series for Nimrep Graphs in Subfactor Theory II: SU(3)

We complete the computation of spectral measures for SU(3) nimrep graphs arising in subfactor theory, namely the SU(3) ADE graphs associated with SU(3) modular invariants and the McKay graphs of finite subgroups of SU(3). For the SU(2) graphs the spectral measures distill onto very special subsets of the semicircle/circle, whilst for the SU(3) graphs the spectral measures distill onto very special subsets of the discoid/torus. The theory of nimreps allows us to compute these measures precisely. We have previously determined spectral measures for some nimrep graphs arising in subfactor theory, particularly those associated with all SU(2) modular invariants, all subgroups of SU(2), the torus, SU(3), and some SU(3) graphs.Comment: 38 pages, 21 figure

The Nakayama automorphism of the almost Calabi-Yau algebras associated to SU(3) modular invariants

We determine the Nakayama automorphism of the almost Calabi-Yau algebra A associated to the braided subfactors or nimrep graphs associated to each SU(3) modular invariant. We use this to determine a resolution of A as an A-A bimodule, which will yield a projective resolution of A.Comment: 46 pages which constitutes the published version, plus an Appendix detailing some long calculations. arXiv admin note: text overlap with arXiv:1110.454