Development of a Certificate in Healthcare Improvement for Inter-Professional Teams

Introduction To address gaps in care team improvement-science education and connect geographically dispersed learners, we created a healthcare improvement certificate program, now completing the third program year, for inter-professional (IP) healthcare teams, including third year medical students. Methods This hybrid learning program consists of five modules: Learning Healthcare Systems, Improvement Science, Patient Safety and Diagnostic Error, Population Health and Health Equity and Leading Change. The curricular materials are comprised of focused readings, concise videos, faculty-moderated discussion boards, weekly synchronous calls of participants with faculty, and a longitudinal improvement project. The faculty are content experts, and worked with a curricular designer to define learning objectives and develop content. Results We have completed three years of this six-month program, training 61 participants (17 of whom were medical students) at 14 sites. In the third year, several medical students participated without an IP team. Development of the materials has been iterative, with feedback from learners and faculty used to shape the materials. Discussion We demonstrate the development and rollout of a hybrid-learning program for diverse and geographically dispersed IP teams, including medical students. Time restrictions limited the depth of topics, and scheduling overlap caused some participants to miss the interactive calls. We plan to evaluate the utility of the program for participants over time, using qualitative methods. Conclusion This educational model is feasible for IP teams studying improvement science and implementing change projects, and can be adopted to dispersed geographic settings

Locality for quantum systems on graphs depends on the number field

Adapting a definition of Aaronson and Ambainis [Theory Comput. 1 (2005), 47--79], we call a quantum dynamics on a digraph "saturated Z-local" if the nonzero transition amplitudes specifying the unitary evolution are in exact correspondence with the directed edges (including loops) of the digraph. This idea appears recurrently in a variety of contexts including angular momentum, quantum chaos, and combinatorial matrix theory. Complete characterization of the digraph properties that allow such a process to exist is a long-standing open question that can also be formulated in terms of minimum rank problems. We prove that saturated Z-local dynamics involving complex amplitudes occur on a proper superset of the digraphs that allow restriction to the real numbers or, even further, the rationals. Consequently, among these fields, complex numbers guarantee the largest possible choice of topologies supporting a discrete quantum evolution. A similar construction separates complex numbers from the skew field of quaternions. The result proposes a concrete ground for distinguishing between complex and quaternionic quantum mechanics.Comment: 9 page

Transcatheter or surgical aortic-valve replacement in intermediate-risk patients

BACKGROUND: Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aorticvalve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients. METHODS: We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement. The primary end point was death from any cause or disabling stroke at 2 years. The primary hypothesis was that TAVR would not be inferior to surgical replacement. Before randomization, patients were entered into one of two cohorts on the basis of clinical and imaging findings; 76.3% of the patients were included in the transfemoral-access cohort and 23.7% in the transthoracic-access cohort. RESULTS: The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2 years, the Kaplan–Meier event rates were 19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P=0.25). In the transfemoralaccess cohort, TAVR resulted in a lower rate of death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the transthoracic-access cohort, outcomes were similar in the two groups. TAVR resulted in larger aortic-valve areas than did surgery and also resulted in lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation; surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation. CONCLUSIONS: In intermediate-risk patients, TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313

Listening to a conversation with aggressive content expands the interpersonal space

The distance individuals maintain between themselves and others can be defined as ‘interpersonal space’. This distance can be modulated both by situational factors and individual characteristics. Here we investigated the influence that the interpretation of other people interaction, in which one is not directly involved, may have on a person’s interpersonal space. In the current study we measured, for the first time, whether the size of interpersonal space changes after listening to other people conversations with neutral or aggressive content. The results showed that the interpersonal space expands after listening to a conversation with aggressive content relative to a conversation with a neutral content. This finding suggests that participants tend to distance themselves from an aggressive confrontation even if they are not involved in it. These results are in line with the view of the interpersonal space as a safety zone surrounding one’s body

Patient's needs and preferences in routine follow-up after treatment for breast cancer

The purpose of the study was to analyse the needs of women who participated in a routine follow-up programme after treatment for primary breast cancer. A cross-sectional survey was conducted using a postal questionnaire among women without any sign of relapse during the routine follow-up period. The questionnaire was sent 2-4 years after primary surgical treatment. Most important to patients was information on long-term effects of treatment and prognosis, discussion of prevention of breast cancer and hereditary factors and changes in the untreated breast. Patients preferred additional investigations (such as X-ray and blood tests) to be part of routine follow-up visits. Less satisfaction with interpersonal aspects and higher scores on the Hospital Anxiety and Depression Scale (HADS) scale were related to stronger preferences for additional investigation. Receiving adjuvant hormonal or radiotherapy was related to a preference for a more intensive follow-up schedule. There were no significant differences between patients treated with mastectomy compared to treated with breast-conserving therapy. During routine follow-up after a diagnosis of breast cancer, not all patients needed all types of information. When introducing alternative follow-up schedules, individual patients' information needs and preferences should be identified early and incorporated into the follow-up routine care, to target resources and maximise the likelihood that positive patient outcomes will result

Advancing nursing practice : the emergence of the role of Advanced Practice Nurse in Saudi Arabia

Background: The roots of advanced practice nursing can be traced back to the 1890s, but the Nurse Practitioner (NP) emerged in Western countries during the 1960s in response to the unmet health care needs of populations in rural areas. These early NPs utilized the medical model of care to assess, diagnose and treat. Nursing has since grown as a profession, with its own unique and distinguishable, holistic, science-based knowledge, which is complementary within the multidisciplinary team. Today Advanced Practice Nurses (APNs) demonstrate nursing expertise in clinical practice, education, research and leadership, and are no longer perceived as “physician replacements” or assistants. Saudi Arabia has yet to define, legislate or regulate Advanced Practice Nursing. Aims: This article aims to disseminate information from a Saudi Advanced Practice Nurse thought leadership meeting, to chronicle the history of Advanced Practice Nursing within the Kingdom of Saudi Arabia, while identifying strategies for moving forward. Conclusion: It is important to build an APN model based on Saudi health care culture and patient population needs, while recognizing global historical underpinnings. Ensuring that nursing continues to distinguish itself from other health care professions, while securing a seat at the multidisciplinary health care table will be instrumental in advancing the practice of nursing

Factors Driving Mercury Variability in the Arctic Atmosphere and Ocean over the Past 30 Years

[1] Long-term observations at Arctic sites (Alert and Zeppelin) show large interannual variability (IAV) in atmospheric mercury (Hg), implying a strong sensitivity of Hg to environmental factors and potentially to climate change. We use the GEOS-Chem global biogeochemical Hg model to interpret these observations and identify the principal drivers of spring and summer IAV in the Arctic atmosphere and surface ocean from 1979–2008. The model has moderate skill in simulating the observed atmospheric IAV at the two sites (r ~ 0.4) and successfully reproduces a long-term shift at Alert in the timing of the spring minimum from May to April (r = 0.7). Principal component analysis indicates that much of the IAV in the model can be explained by a single climate mode with high temperatures, low sea ice fraction, low cloudiness, and shallow boundary layer. This mode drives decreased bromine-driven deposition in spring and increased ocean evasion in summer. In the Arctic surface ocean, we find that the IAV for modeled total Hg is dominated by the meltwater flux of Hg previously deposited to sea ice, which is largest in years with high solar radiation (clear skies) and cold spring air temperature. Climate change in the Arctic is projected to result in increased cloudiness and strong warming in spring, which may thus lead to decreased Hg inputs to the Arctic Ocean. The effect of climate change on Hg discharges from Arctic rivers remains a major source of uncertainty.Earth and Planetary SciencesEngineering and Applied Science

The role of the cerebellum in adaptation: ALE meta‐analyses on sensory feedback error

It is widely accepted that unexpected sensory consequences of self‐action engage the cerebellum. However, we currently lack consensus on where in the cerebellum, we find fine‐grained differentiation to unexpected sensory feedback. This may result from methodological diversity in task‐based human neuroimaging studies that experimentally alter the quality of self‐generated sensory feedback. We gathered existing studies that manipulated sensory feedback using a variety of methodological approaches and performed activation likelihood estimation (ALE) meta‐analyses. Only half of these studies reported cerebellar activation with considerable variation in spatial location. Consequently, ALE analyses did not reveal significantly increased likelihood of activation in the cerebellum despite the broad scientific consensus of the cerebellum's involvement. In light of the high degree of methodological variability in published studies, we tested for statistical dependence between methodological factors that varied across the published studies. Experiments that elicited an adaptive response to continuously altered sensory feedback more frequently reported activation in the cerebellum than those experiments that did not induce adaptation. These findings may explain the surprisingly low rate of significant cerebellar activation across brain imaging studies investigating unexpected sensory feedback. Furthermore, limitations of functional magnetic resonance imaging to probe the cerebellum could play a role as climbing fiber activity associated with feedback error processing may not be captured by it. We provide methodological recommendations that may guide future studies

Understanding the retinal basis of vision across species

The vertebrate retina first evolved some 500 million years ago in ancestral marine chordates. Since then, the eyes of different species have been tuned to best support their unique visuoecological lifestyles. Visual specializations in eye designs, large-scale inhomogeneities across the retinal surface and local circuit motifs mean that all species' retinas are unique. Computational theories, such as the efficient coding hypothesis, have come a long way towards an explanation of the basic features of retinal organization and function; however, they cannot explain the full extent of retinal diversity within and across species. To build a truly general understanding of vertebrate vision and the retina's computational purpose, it is therefore important to more quantitatively relate different species' retinal functions to their specific natural environments and behavioural requirements. Ultimately, the goal of such efforts should be to build up to a more general theory of vision

Effects of prophylactic knee bracing on patellar tendon loading parameters during functional sports tasks in recreational athletes

Purpose This study investigated the efects of prophylactic knee bracing on patellar tendon loading parameters. Methods Twenty recreational athletes (10 male and 10 female) from diferent athletic disciplines performed run, cut and single leg hop movements under two conditions (prophylactic knee brace/no-brace). Lower extremity kinetics and kinematics were examined using a piezoelectric force plate and three-dimensional motion capture system. Patellar tendon loading was explored using a mathematical modelling approach, which accounted for co-contraction of the knee lexors. Tendon loading parameters were examined using 2 (brace) × 3 (movement) × 2 (sex) mixed ANOVAs. Results Tendon instantaneous load rate was signiicantly reduced in female athletes in the run (brace 289.14 BW/s no-brace 370.06 BW/s) and cut (brace 353.17 BW/s/no-brace 422.01 BW/s) conditions whilst wearing the brace. Conclusions Female athletes may be able to attenuate their risk from patellar tendinopathy during athletic movements, through utilization of knee bracing, although further prospective research into the prophylactic efects of knee bracing is required before this can be clinically substantiated