Documenting Body Mass Index and Lifestyle Counseling for Pediatric Patients: A Quality Improvement Project at a Federally Qualified Healthcare Facility

Background: Screening and monitoring growth throughout childhood and adolescence, as well as providing the necessary education on positive lifestyle choices is vital in combating the childhood obesity epidemic. Counseling children on the importance of nutrition and physical activity also helps to prevent numerous comorbid conditions associated with obesity. The United States. Preventive Services Task Force recommends that healthcare workers screen for obesity at least annually in all patients 3-17 years of age, as well as offer lifestyle counseling regardless of Body Mass Index ranking. Aim: The aim of this quality improvement project was to improve the current percentage of pediatric patients with up-to-date documentation of Body Mass Index percentile and proof of receiving counseling for both physical activity and nutrition. Specifically, this project aimed to increase child BMI screening and counseling rates at a federally qualified healthcare facility from 49% to the agency goal of 60% by July 30th, 2022. Interventions: A root-cause analysis was performed by completing an initial chart audit of 176 patient charts. After analyzing the audit results it was determined that the most common error was failure to document providing patient education on physical activity and nutrition. This information was then used to develop an educational presentation for clinical staff to learn about the measure and how to properly document patient counseling in the Electronic Medical Record. A focus group was then conducted to understand the current barriers staff face with meeting the measure, and receive feedback on ways to improve. The two providers with the lowest compliance rates were given additional education on documenting the measure and at-the-elbow support was provided. Results: The data revealed that the educational intervention had not been effective in improving compliance rates of the measure. By the end of June 2022, the percent compliance rate had actually decreased to 46%. During the focus group staff expressed concerns about not having enough time to complete education, along with having their patients present annually for physical exams. Discussion: Screening pediatric patients for obesity, in addition to providing the appropriate education for implementing healthy lifestyle habits is vital for growth and development. As the results have shown the educational intervention to be unsuccessful, a different approach should be taken in the future to help improve compliance. Implications for the CNL: Focusing on the role of the CNL, healthcare technologies were used to obtain and evaluate data regarding the quality of patient-centered care. Leadership and communication skills were utilized to strengthen interprofessional partnerships, which served as vital during the implementation phase. The necessary steps taken throughout this project has emphasized the roles of the CNL as a lifelong learner, continuously striving to improve the quality of healthcare

Rapid enhancement of touch from non-informative vision of the hand

Processing in one sensory modality may modulate processing in another. Here we investigate how simply viewing the hand can influence the sense of touch. Previous studies showed that non-informative vision of the hand enhances tactile acuity, relative to viewing an object at the same location. However, it remains unclear whether this Visual Enhancement of Touch (VET) involves a phasic enhancement of tactile processing circuits triggered by the visual event of seeing the hand, or more prolonged, tonic neuroplastic changes, such as recruitment of additional cortical areas for tactile processing. We recorded somatosensory evoked potentials (SEPs) evoked by electrical stimulation of the right middle finger, both before and shortly after viewing either the right hand, or a neutral object presented via a mirror. Crucially, and unlike prior studies, our visual exposures were unpredictable and brief, in addition to being non-informative about touch. Viewing the hand, as opposed to viewing an object, enhanced tactile spatial discrimination measured using grating orientation judgements, and also the P50 SEP component, which has been linked to early somatosensory cortical processing. This was a trial-specific, phasic effect, occurring within a few seconds of each visual onset, rather than an accumulating, tonic effect. Thus, somatosensory cortical modulation can be triggered even by a brief, non-informative glimpse of one’s hand. Such rapid multisensory modulation reveals novel aspects of the specialised brain systems for functionally representing the body

Visual enhancement of touch and the bodily self

We experience our own body through both touch and vision. We further see that others’ bodies are similar to our own body, but we have no direct experience of touch on others’ bodies. Therefore, relations between vision and touch are important for the sense of self and for mental representation of one’s own body. For example, seeing the hand improves tactile acuity on the hand, compared to seeing a non-hand object. While several studies have demonstrated this visual enhancement of touch (VET) effect, its relation to the ‘bodily self’, or mental representation of one’s own body remains unclear. We examined whether VET is an effect of seeing a hand, or of seeing my hand, using the rubber hand illusion. In this illusion, a prosthetic hand which is brushed synchronously—but not asynchronously—with one’s own hand is felt to actually be one’s hand. Thus, we manipulated whether or not participants felt like they were looking directly at their hand, while holding the actual stimulus they viewed constant. Tactile acuity was measured by having participants judge the orientation of square-wave gratings. Two characteristic effects of VET were observed: (1) cross-modal enhancement from seeing the hand was inversely related to overall tactile acuity, and (2) participants near sensory threshold showed significant improvement following synchronous stroking, compared to asynchronous stroking or no stroking at all. These results demonstrate a clear functional relation between the bodily self and basic tactile perception

Monensin Improves the Effectiveness of meso-Dimercaptosuccinate when Used to Treat Lead Intoxication in Rats

Among divalent cations, the ionophore monensin shows high activity and selectivity for the transport of lead ions (Pb(2+)) across phospholipid membranes. When coadministered to rats that were receiving meso-dimercaptosuccinate for treatment of Pb intoxication, monensin significantly increased the amount of Pb removed from femur, brain, and heart. It showed a tendency to increase Pb removal from liver and kidney but had no effect of this type in skeletal muscle. Tissue levels of several physiologic (calcium, cobalt, copper, iron, magnesium, manganese, molybdenum, zinc) and nonphysiologic (arsenic, cadmium, chromium, nickel, strontium) elements were also determined after the application of these compounds. Among the physiologic elements, a number of significant changes were seen, including both rising and falling values. The size of these changes was typically around 20% compared with control values, with the largest examples seen in femur. These changes often tended to reverse those of similar size that had occurred during Pb administration. Among the nonphysiologic elements, which were present in trace amounts, the changes were smaller in number but larger in size. None of these changes appears likely to be significant in terms of toxicity, and there were no signs of overt toxicity under any of the conditions employed. Monensin may act by cotransporting Pb(2+) and OH(–) ions out of cells, in exchange for external sodium ions. The net effect would be to shuttle intracellular Pb(2+) to extracellular dimercaptosuccinic acid thereby enhancing its effectiveness. Thus, monensin may be useful for the treatment of Pb intoxication when applied in combination with hydrophilic Pb(2+) chelators

Standalone vertex finding in the ATLAS muon spectrometer

A dedicated reconstruction algorithm to find decay vertices in the ATLAS muon spectrometer is presented. The algorithm searches the region just upstream of or inside the muon spectrometer volume for multi-particle vertices that originate from the decay of particles with long decay paths. The performance of the algorithm is evaluated using both a sample of simulated Higgs boson events, in which the Higgs boson decays to long-lived neutral particles that in turn decay to bbar b final states, and pp collision data at √s = 7 TeV collected with the ATLAS detector at the LHC during 2011

Measurements of Higgs boson production and couplings in diboson final states with the ATLAS detector at the LHC

Measurements are presented of production properties and couplings of the recently discovered Higgs boson using the decays into boson pairs, H →γ γ, H → Z Z∗ →4l and H →W W∗ →lνlν. The results are based on the complete pp collision data sample recorded by the ATLAS experiment at the CERN Large Hadron Collider at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV, corresponding to an integrated luminosity of about 25 fb−1. Evidence for Higgs boson production through vector-boson fusion is reported. Results of combined fits probing Higgs boson couplings to fermions and bosons, as well as anomalous contributions to loop-induced production and decay modes, are presented. All measurements are consistent with expectations for the Standard Model Higgs boson

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE

Measurement of the t t-bar production cross section in the dilepton channel in pp collisions at sqrt(s) = 7 TeV

The t t-bar production cross section (sigma[t t-bar]) is measured in proton-proton collisions at sqrt(s) = 7 TeV in data collected by the CMS experiment, corresponding to an integrated luminosity of 2.3 inverse femtobarns. The measurement is performed in events with two leptons (electrons or muons) in the final state, at least two jets identified as jets originating from b quarks, and the presence of an imbalance in transverse momentum. The measured value of sigma[t t-bar] for a top-quark mass of 172.5 GeV is 161.9 +/- 2.5 (stat.) +5.1/-5.0 (syst.) +/- 3.6(lumi.) pb, consistent with the prediction of the standard model.Comment: Replaced with published version. Included journal reference and DO

Combined search for the quarks of a sequential fourth generation

Results are presented from a search for a fourth generation of quarks produced singly or in pairs in a data set corresponding to an integrated luminosity of 5 inverse femtobarns recorded by the CMS experiment at the LHC in 2011. A novel strategy has been developed for a combined search for quarks of the up and down type in decay channels with at least one isolated muon or electron. Limits on the mass of the fourth-generation quarks and the relevant Cabibbo-Kobayashi-Maskawa matrix elements are derived in the context of a simple extension of the standard model with a sequential fourth generation of fermions. The existence of mass-degenerate fourth-generation quarks with masses below 685 GeV is excluded at 95% confidence level for minimal off-diagonal mixing between the third- and the fourth-generation quarks. With a mass difference of 25 GeV between the quark masses, the obtained limit on the masses of the fourth-generation quarks shifts by about +/- 20 GeV. These results significantly reduce the allowed parameter space for a fourth generation of fermions.Comment: Replaced with published version. Added journal reference and DO