Changes in error rates in the Australian key incident monitoring and management system program

Introduction: The Key incident monitoring and management system program (KIMMS) program collects data for 19 quality indicators (QIs) from Australian medical laboratories. This paper aims to review the data submitted to see whether the number of errors with a higher risk priority number (RPN) have been reduced in preference to those with a lower RPN, and to calculate the cost of these errors. Materials and methods: Data for QIs from 60 laboratories collected through the KIMMS program from 2015 until 2018 were retrospectively reviewed. The results for each QI were averaged for the four-year average and coefficient of variation. To review the changes in QI frequency, the yearly averages for 2015 and 2018 were compared. By dividing the total RPN by 4 and multiplying that number by the cost of recollection of 30 AUD, it was possible to assign the risk cost of these errors. Results: The analysis showed a drop in the overall frequency of incidents (6.5%), but a larger drop in risk (9.4%) over the period investigated. Recollections per year in Australia cost the healthcare industry 27 million AUD. If the RPN data is used, this cost increases to 66 million AUD per year. Conclusions: Errors with a higher RPN have fallen more than those with lower RPN. The data shows that the errors associated with phlebotomy are the ones that have most improved. Further improvements require a better understanding of the root cause of the errors and to achieve this, work is required in the collection of the data to establish best-practice guidelines

Networks of Opportunity: Public Engagement Survey Results

The Project for Public Spaces notes, “People who use a public space are the ones who know, from experience, which areas are dangerous and why, which spaces are comfortable, where traffic moves too quickly and how certain aspects of a space could be improved” (2011, p. 13). Therefore, public engagement was a core part of our project. As previously stated, one major objective of this project is to propose safer paths to school for students. This objective stems from the fact that no bus services are provided to children who live within 1 mile of an elementary school, 1.5 miles of a middle school, and 2 miles of a high school. Since Pacer Planning could not gain students’ input for ethical reasons, target stakeholders that can act as proxies for the student population are the City’s Parent Teacher Organizations (PTOs), public safety officials, and school administration officials. In a similar vein, the target population includes students’ parents. Gaining these individuals’ input on where problem areas exist would provide invaluable insight when formulating our recommendations

A pooled long-term follow-up after radiotherapy for prostate cancer with and without a rectal hydrogel spacer: Impact of hydrogel on decline in sexual quality of life

PURPOSE: The purpose of this study was to analyze the impact of prostate rectal spacers on sexual quality of life (QOL) following external beam radiation therapy (RT). METHODS AND MATERIALS: Patient- reported QOL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC). Patients were pooled from two sources: a randomized controlled trial and a non-randomized cohort of patients from a single institution. Both cohorts used the same spacing product and QOL instrument. Analysis was limited to those with good baseline pre-treatment sexual QOL (EPIC \u3e/= 60). Differences in QOL summary score and individual items were assessed compared with baseline and between treatment arms. RESULTS: A total of 128 men had good baseline sexual function and were evaluated (64% with spacer and 36% without) with QOL data available for median 33 months (range: 2.5-69.4 months). Men without spacer were more likely to have declines in sexual function ( CONCLUSION: In this pooled analysis of QOL after prostate RT, the utilization of a hydrogel spacer was associated with better sexual QOL, less men with measurable declines in sexual QOL, and higher rates of adequate erectile function

Human Developmental Chondrogenesis as a Basis for Engineering Chondrocytes from Pluripotent Stem Cells

Joint injury and osteoarthritis affect millions of people worldwide, but attempts to generate articular cartilage using adult stem/progenitor cells have been unsuccessful. We hypothesized that recapitulation of the human developmental chondrogenic program using pluripotent stem cells (PSCs) may represent a superior approach for cartilage restoration. Using laser-capture microdissection followed by microarray analysis, we first defined a surface phenotype (CD166(low/neg)CD146(low/neg)CD73(+)CD44(low)BMPR1B(+)) distinguishing the earliest cartilage committed cells (prechondrocytes) at 5-6 weeks of development. Functional studies confirmed these cells are chondrocyte progenitors. From 12 weeks, only the superficial layers of articular cartilage were enriched in cells with this progenitor phenotype. Isolation of cells with a similar immunophenotype from differentiating human PSCs revealed a population of CD166(low/neg)BMPR1B(+) putative cartilage-committed progenitors. Taken as a whole, these data define a developmental approach for the generation of highly purified functional human chondrocytes from PSCs that could enable substantial progress in cartilage tissue engineering.Fil: Wu, Ling. University of California at Los Angeles; Estados UnidosFil: Bluguermann, Carolina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Laboratorio de Biología del Desarrollo Celular; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. University of California at Los Angeles; Estados UnidosFil: Kyupelyan, Levon. University of California at Los Angeles; Estados UnidosFil: Latour, Brooke. University of California at Los Angeles; Estados UnidosFil: Gonzalez, Stephanie. University of California at Los Angeles; Estados UnidosFil: Shah, Saumya. University of California at Los Angeles; Estados UnidosFil: Galic, Zoran. University of California at Los Angeles; Estados UnidosFil: Ge, Sundi. University of California at Los Angeles; Estados UnidosFil: Zhu, Yuhua. University of California at Los Angeles; Estados UnidosFil: Petrigliano, Frank A.. University of California at Los Angeles; Estados UnidosFil: Nsair, Ali. University of California at Los Angeles; Estados UnidosFil: Miriuka, Santiago Gabriel. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Laboratorio de Biología del Desarrollo Celular; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Li, Xinmin. University of California at Los Angeles; Estados UnidosFil: Lyons, Karen M.. University of California at Los Angeles; Estados UnidosFil: Crooks, Gay M.. University of California at Los Angeles; Estados UnidosFil: McAllister, David R.. University of California at Los Angeles; Estados UnidosFil: Van Handel, Ben. Novogenix Laboratories; Estados UnidosFil: Adams, John S.. University of California at Los Angeles; Estados UnidosFil: Evseenko, Denis. University of California at Los Angeles; Estados Unido

Networks of Opportunity: A Citywide Vision for Pedestrian and Bicycle Pathways in Chicopee, Massachusetts

The goal of the Master of Regional Planning Studio is to develop a student’s techniques for collecting, analyzing, and synthesizing spatial and non-spatial data and then presenting that collective data in a manner (i.e., report, video, presentation, and charettes) that is understandable to academics, professionals, and the public. Planning Studio allows students to integrate knowledge from coursework and research, and apply such knowledge to resolving representative planning problems. At UMASS Amherst, these problems are found in neighborhood, rural, urban, and/or regional settings. In the fall of 2016, the City of Chicopee gave the Regional Planning Studio four directives that aim to increase local and regional connections for the City’s pedestrians and bicyclists. The directives are as follows: A delineation of sectors, or cohesive spatial sub-units, that will divide the City and serve as the backbone of a vision for pedestrian and bicycle networks. The definition of key destinations within each of these sectors, which will serve as nodes to connect the districts. The creation of proposed paths, which will function as connections between destination points. Public engagement centered on soliciting input from community members and stakeholder groups impacted by safe walking and bicycling routes to school. These directives stem from the Chicopee Planning Department’s observation that the City’s data pedestrian access illustrate highly inconsistent and incomplete sidewalk network. These conditions have resulted in pedestrian access challenges to major local destinations including schools, recreational facilities, commercial areas, services, and surrounding communities. Networks of Opportunity: A Citywide Vision for Pedestrian and Bicycle Pathways in Chicopee, Massachusetts aims to improve pedestrian and bicyclist safety by suggesting paths that transverse the city, infrastructure improvements to make key roads safer for all users, and highlight local recreational and cultural opportunities for community residents

A New Linear Logic for Deadlock-Free Session-Typed Processes

The π -calculus, viewed as a core concurrent programming language, has been used as the target of much research on type systems for concurrency. In this paper we propose a new type system for deadlock-free session-typed π -calculus processes, by integrating two separate lines of work. The first is the propositions-as-types approach by Caires and Pfenning, which provides a linear logic foundation for session types and guarantees deadlock-freedom by forbidding cyclic process connections. The second is Kobayashi’s approach in which types are annotated with priorities so that the type system can check whether or not processes contain genuine cyclic dependencies between communication operations. We combine these two techniques for the first time, and define a new and more expressive variant of classical linear logic with a proof assignment that gives a session type system with Kobayashi-style priorities. This can be seen in three ways: (i) as a new linear logic in which cyclic structures can be derived and a CYCLE -elimination theorem generalises CUT -elimination; (ii) as a logically-based session type system, which is more expressive than Caires and Pfenning’s; (iii) as a logical foundation for Kobayashi’s system, bringing it into the sphere of the propositions-as-types paradigm

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

Abstract Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended). Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended. Conclusions Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. Trial registration ClinicalTrials.gov, NCT0130921

Brain-responsive neurostimulation for the treatment of adults with epilepsy in tuberous sclerosis complex: A case series

OBJECTIVE: Tuberous sclerosis complex (TSC) is a genetic disorder primarily characterized by the development of multisystem benign tumors. Epilepsy is the most common neurologic manifestation, affecting 80%-90% of TSC patients. The diffuse structural brain abnormalities and the multifocal nature of epilepsy in TSC pose diagnostic challenges when evaluating patients for epilepsy surgery. METHODS: We retrospectively reviewed the safety experience and efficacy outcomes of five adult TSC patients who were treated with direct brain-responsive neurostimulation (RNS System, NeuroPace, Inc). RESULTS: The average follow-up duration was 20 months. All five patients were responders (≥50% disabling seizure reduction) at last follow-up. The median reduction in disabling seizures was 58% at 1 year and 88% at last follow-up. Three of the five patients experienced some period of seizure freedom ranging from 3 months to over 1 year. SIGNIFICANCE: In this small case series, we report the first safety experience and efficacy outcomes in patients with TSC-associated drug-resistant focal epilepsy treated with direct brain-responsive neurostimulation

Machine-Checked Semantic Session Typing

Session types- A family of type systems for message-passing concurrency-have been subject to many extensions, where each extension comes with a separate proof of type safety. These extensions cannot be readily combined, and their proofs of type safety are generally not machine checked, making their correctness less trustworthy. We overcome these shortcomings with a semantic approach to binary asynchronous affine session types, by developing a logical relations model in Coq using the Iris program logic. We demonstrate the power of our approach by combining various forms of polymorphism and recursion, asynchronous subtyping, references, and locks/mutexes. As an additional benefit of the semantic approach, we demonstrate how to manually prove typing judgements of racy, but safe, programs that cannot be type checked using only the rules of the type system. Programming Language