A patient based teaching module on the pharmacology of anesthetic drugs

Background Medical students who take electives in Anesthesiology often lack formal training in the pharmacology of the medications used by anesthesiologists. The clinical learning environment in the OR is often not conducive to comprehensive teaching opportunities, as patient care is the primary focus. Providing a teaching module on a portable device such as an iPad would facilitate a standardized learning approach for these students to learn about anesthetic drugs in the clinical OR setting. Objectives To develop a digital, interactive learning module on the pharmacology and clinical application of anesthetic drugs for medical students interested in anesthesia. Methods We compiled learning materials on the pharmacology of various classes of Anesthetic agents. We also designed virtual patient cases and coupled them with the background pharmacology. The resulting module was formatted on an iPad for ready access in the OR setting. Results The project will be completed throughout summer 2012; therefore results have not yet been obtained. The intention is to evaluate the effectiveness of this module for student learning either through a quality assurance questionnaire or formal testing of retained material once we have the module complete and functional

Rare case of gastropericardial fistula after Roux-en-Y gastric bypass

Abstract"Roux-en-Y gastric bypass (RYGB) is a widely used surgery in the management of obesity. Common late complications of RYGB include: Anastomotic stricture, small bowel obstruction, internal hernia, dumping syndrome, cholelithiasis, malnutrition, marginal ulceration, gastro-gastric fistula. Gastropericardial fistulas are an extremely rare but lifethreatening late complication. [less than] 70 cases in modern literature from review in 2016. Mean time of presentation 84 months after surgery (median 60 months). Prior operative risk factors include open or laparoscopic Nissen fundoplication, esophagectomy, hiatal hernia repair, laparoscopic gastric banding and RYGB."--Introduction

2024-2025 Growth, Physiology, Yield, and Quality Evaluation of Small Grain Varieties in Central Arizona

Choosing an appropriate crop variety is critical for farmers, especially in Arizona’s small-grain production systems. There exists considerable variation among small grain varieties, with each displaying distinct levels of adaptability and performance traits that ultimately affect the profitability of farming ventures. The performance of varieties can fluctuate significantly from year to year, highlighting the importance of conducting evaluations across multiple site-years to assess a variety's yield potential accurately.Financial support for this project was received from the Arizona Grain Research and Promotion Council and the Arizona Crop Improvement Association

Urban air pollution produces up-regulation of myocardial inflammatory genes and dark chocolate provides cardioprotection

Air pollution is a serious environmental problem. Elderly subjects show increased cardiac morbidity and mortality associated with air pollution exposure. Mexico City (MC) residents are chronically exposed to high concentrations of fine particulate matter (PM2.5) and PM-associated lipopolysaccharides (PM-LPS). To test the hypothesis that chronic exposure to urban pollution produces myocardial inflammation, female Balb-c mice age 4 weeks were exposed for 16 months to two distinctly different polluted areas within MC: Southwest (SW) and Northwest (NW). SW mice were given either no treatment or chocolate 2g/9.5 mg polyphenols/3 times per week. Results were compared to mice kept in clean air. Key inflammatory mediator genes: cyclooxygenase-2 (COX-2), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and the LPS receptor CD14 (cluster of differentiation antigen 14) were measured by real time polymerase chain reaction. Also explored were target NFκB (Nuclear Factor κ B), oxidative stress and antioxidant defense genes

Intra-city Differences in Cardiac Expression of Inflammatory Genes and Inflammasomes in Young Urbanites: A Pilot Study

Southwest Mexico City (SWMC) air pollution is characterized by high concentrations of ozone and particulate matter < 10 μm (PM10) containing lipopolysaccharides while in the North PM2.5 is high. These intra-city differences are likely accounting for higher CD14 and IL-1β in SWMC v NMC mice myocardial expression. This pilot study was designed to investigate whether similar intra-city differences exist in the levels of myocardial inflammatory genes in young people. Inflammatory mediator genes and inflammasome arrays were measured in right and left autopsy ventricles of 6 southwest/15 north (18.5 ± 2.6 years) MC residents after fatal sudden accidental deaths. There was a significant S v N right ventricle up-regulation of IL-1β (p=0.008), TNF-α (p=0.001), IL-10 (p=0.001), and CD14 (p=0.002), and a left ventricle difference in TNF-α (p=0.007), and IL-10 (p=0.02). SW right ventricles had significant up-regulation of NLRC1, NLRP3 and of 29/84 inflammasome genes, including NOD factors and caspases. There was significant degranulation of mast cells both in myocardium and epicardial nerve fibers. Differential expression of key inflammatory myocardial genes and inflammasomes are influenced by the location of residence. Myocardial inflammation and inflammasome activation in young hearts is a plausible pathway of heart injury in urbanites and adverse effects on the cardiovascular system are expected

Margarita de Sossa, Sixteenth-Century Puebla de los Ángeles, New Spain (Mexico)

Margarita de Sossa’s freedom journey was defiant and entrepreneurial. In her early twenties, still enslaved in Portugal, she took possession of her body; after refusing to endure her owner’s sexual demands, he sold her, and she was transported to Mexico. There, she purchased her freedom with money earned as a healer and then conducted an enviable business as an innkeeper. Sossa’s biography provides striking insights into how she conceptualized freedom in terms that included – but was not limited to – legal manumission. Her transatlantic biography offers a rare insight into the life of a free black woman (and former slave) in late sixteenth-century Puebla, who sought to establish various degrees of freedom for herself. Whether she was refusing to acquiesce to an abusive owner, embracing entrepreneurship, marrying, purchasing her own slave property, or later using the courts to petition for divorce. Sossa continued to advocate on her own behalf. Her biography shows that obtaining legal manumission was not always equivalent to independence and autonomy, particularly if married to an abusive husband, or if financial successes inspired the envy of neighbors

Furthering an Innovative Approach to Caring for the Frail Elderly

internship report - winter 2016People over the age of 65 (seniors) are the fastest growing demographic in Canada representing approximately 15% of the total national population in 2013 and expecting to grow to 24% by 2036 (Statistics Canada). The cost of caring for this seniors’ population is disproportionately high at 45% of the healthcare spending. A significant driver of this cost is frailty, the progressive physiological decline in function, cognition, and mobility accompanied by a loss of physiological reserve and increased vulnerability to disease and death (Moorhouse, 2012). The Palliative and Therapeutic Harmonization (PATH) model is an innovative approach to simplifying the process of caring for the frail elderly that is shown to produce a dramatic change in the cost of care and the quality of patient and family caregiver satisfaction with the healthcare system (Moorhouse, Mallery, 2012). The PATH model of care was developed by Drs. Mallery and Moorhouse who practice geriatric medicine at the QEII Hospital in Halifax, NS. Deloitte has been working with PATH Inc. for over two years to support the adoption of the PATH model of care across Canada and beyond. As part of this adoption effort, Deloitte was engaged by the Tideview Terrace Long-term Care facility in Digby, NS to perform a PATH Implementation readiness assessment and to identify and recommend any preparatory actions that Tideview Terrace would need to undertake prior to implementing the PATH care model. The author, along with a team of healthcare consulting professionals, planned and performed the readiness assessment and identified and presented 56 recommendations to the Tideview Terrace leadership. Through this process there were additional objectives that were addressed including the documentation of the approach, processes and tools used to complete the readiness assessment to enable repeatability of the process, as well as a detailed analysis of an identified implementation issue that has far reaching impacts beyond the current client environment. This report details the author’s work on the readiness assessment and resulting findings as well as the activities and analysis performed to support the secondary objectives of the project.Deloitte Inc., Halifa