Defining the critical limit of oxygen extraction in the human small intestine

AbstractAlthough animal models have been used to characterize the relation between oxygen consumption and blood flow, reliable data have not been generated in the human small intestine. We perfused segments of human small intestine by using an ex vivo perfusion circuit that allowed precise manipulation of blood flow and perfusion pressure. Our goal was to define the critical level of intestinal blood flow necessary to maintain the metabolic needs of the tissue. Human small intestine (n = 5) tissue obtained at transplantation harvest was transported on ice to the laboratory. A 40-cm mid-jejunal segment was selected for perfusion, and appropriate inflow and outflow vessels were identified and cannulated. Perfusion with an autologous blood solution was initiated through an extracorporeal membrane oxygenation circuit. After a 30-minute equilibration period, arterial and venous blood gases were measured at varying flow rates while maintaining a constant hematocrit level. Arterial and venous oxygen content, arteriovenous oxygen difference (A-VO2 diff), and oxygen consumption (O 2 ) were then calculated. Our results demonstrated that at blood flows >30 ml/min/100 g, O 2 is independent of blood flow (1.6 ± 0.06 ml/min/100 g), and oxygen extraction is inversely related to flow. Below this blood flow rate of 30 ml/min/100 g, oxygen extraction does not increase further (6.3 ± 0.3 vol%), and O 2 becomes flow dependent. This ex vivo preparation defines for the first time a threshold value of blood flow for small intestine below which oxygen consumption decreases (30 ml/min/100 g). Previous animal studies have correlated such a decrease in oxygen consumption with functional and histologic evidence of tissue injury. This “critical” flow rate in human intestine is similar to that found previously in canine and feline intestine, but lower than that of rodent species. (J Vasc Surg 1996;23:832-8.

Tissue hydrogen ion concentration in ischemic muscle: Effects of gradual and acute arterial occlusion, with and without acute venous hypertension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22874/1/0000437.pd

Planning an Escape: Considerations for the Development of Applied Escape Rooms

Background. Teams are essential to a wide array of applications and organizations often utilize varying interventions to improve the effectiveness of their teams. Due to their collaborative and modifiable characteristics, escape rooms are being increasingly utilized as an avenue to both deliver team interventions and to function as testbeds in research. Escape rooms are complex, interdependent activities which warrant careful planning to be effectively implemented. Despite the growing literature base concerning escape rooms, there is still limited practical guidance to inform the development of an escape room. Aim. The purpose of this article is to provide seven considerations that are relevant to the development, implementation, and effectiveness of an escape room. Specifically, guidance is provided in determining the objectives, identifying a theme, assigning the roles, establishing participant interdependence, selecting a venue, designing the puzzles, and creating the assessments. Conclusion. The considerations provided in this article can advance the science underlying the use of escape rooms and preclude difficulties associated with their use

Unlocking the Methodology Of Escape Rooms: Considerations For Conducting Applied Escape Rooms in Research

Background. Teams are the foundation of modern organizations. Many organizations are interested in interventions to bolster the effectiveness of their workforce. One viable intervention is an escape room. Escape rooms are engaging, team based activities that require individuals to work together to complete multiple tasks in a limited amount of time. Purpose. The purpose of this article is to provide ten considerations that are relevant to leveraging escape rooms as a means for data collection. Specifically, we offer guidance regarding pilot testing, equipment set-up, participant recruitment, briefing participants, progress monitoring, hints, room maintenance, data maintenance and analysis, and revising the room and study. Conclusion. The considerations provided in this article can assist researchers when attempting to employ an escape room as a mechanism to collect data

Advancing Team Cohesion: Using an Escape Room as a Novel Approach

Objective: An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods: This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post- escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results: Sixty-two teams participated (n 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) 24.10, p \u3c .001; Wilks’ K .725; partial g2 .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions: This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums

DIAGNOSIS OF SUPERIOR-VENE-CAVA OBSTRUCTION

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22307/1/0000751.pd

Renal:Systemic renin indices and renal vein renin ratios as prognostic indicators in remedial renovascular hypertension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21815/1/0000215.pd

Prostaglandin F2[alpha] attenuation of aortic declamping hyperemia and hypotension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/21783/1/0000178.pd