Preventing Isolated Perioperative Reintubation: Who is at highest risk?

Objectives: 1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF). 2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.https://jdc.jefferson.edu/patientsafetyposters/1041/thumbnail.jp

A Functional Land Management conceptual framework under soil drainage and land use scenarios

peer-reviewedAgricultural soils offer multiple soil functions, which contribute to a range of ecosystem services, and the demand for the primary production function is expected to increase with a growing world population. Other key functions on agricultural land have been identified as water purification, carbon sequestration, habitat biodiversity and nutrient cycling, which all need to be considered for sustainable intensification. All soils perform all functions simultaneously, but the variation in the capacity of soils to supply these functions is reviewed in terms of defined land use types (arable, bio-energy, broadleaf forest, coniferous forest, managed grassland, other grassland and Natura 2000) and extended to include the influence of soil drainage characteristics (well, moderately/imperfect, poor and peat). This latter consideration is particularly important in the European Atlantic pedo-climatic zone; the spatial scale of this review. This review develops a conceptual framework on the multi-functional capacity of soils, termed Functional Land Management, to facilitate the effective design and assessment of agri-environmental policies. A final functional soil matrix is presented as an approach to show the consequential changes to the capacity of the five soil functions associated with land use change on soils with contrasting drainage characteristics. Where policy prioritises the enhancement of particular functions, the matrix indicates the potential trade-offs for individual functions or the overall impact on the multi-functional capacity of soil. The conceptual framework is also applied by land use area in a case study, using the Republic of Ireland as an example, to show how the principle of multi-functional land use planning can be readily implemented

Predicting risk of COPD in primary care:development and validation of a clinical risk score

OBJECTIVES: To develop and validate a clinical risk score to identify patients at risk of chronic obstructive pulmonary disease (COPD) using clinical factors routinely recorded in primary care. DESIGN: Case–control study of patients containing one incident COPD case to two controls matched on age, sex and general practice. Candidate risk factors were included in a conditional logistic regression model to produce a clinical score. Accuracy of the score was estimated on a separate external validation sample derived from 20 purposively selected practices. SETTING: UK general practices enrolled in the Clinical Practice Research Datalink (1 January 2000 to 31 March 2006). PARTICIPANTS: Development sample included 340 practices containing 15 159 newly diagnosed COPD cases and 28 296 controls (mean age 70 years, 52% male). Validation sample included 2259 cases and 4196 controls (mean age 70 years, 50% male). MAIN OUTCOME MEASURES: Area under the receiver operator characteristic curve (c statistic), sensitivity and specificity in the validation practices. RESULTS: The model included four variables including smoking status, history of asthma, and lower respiratory tract infections and prescription of salbutamol in the previous 3 years. It had a high average c statistic of 0.85 (95% CI 0.83 to 0.86) and yielded a sensitivity of 63.2% (95% CI 63.1 to 63.3) and specificity 87.4% (95% CI 87.3 to 87.5). CONCLUSIONS: Risk factors associated with COPD and routinely recorded in primary care have been used to develop and externally validate a new COPD risk score. This could be used to target patients for case finding

What motivates primary healthcare practitioners to refer patients with Chronic Obstructive Pulmonary Disease (COPD) to Pulmonary Rehabilitation? A survey using the Theoretical Domains Framework

Background: Pulmonary rehabilitation (PR) is a highly effective intervention for patients with COPD but primary care referral rates are persistently low. The Theoretical Domains Framework (TDF) provides a structure for identifying motivators for behaviour change. Aim: Using the TDF to identify & classify the key barriers and enablers for UK primary healthcare practitioners (PHPs) when referring patients with COPD to PR. Methodology: A 54-item questionnaire, derived from our previous qualitative study and guided by the TDF, was distributed to UK based PHPs. Participants were recruited by e-mail (Primary Care Respiratory Society members), social media or direct targeting of participants at PHP conferences. Descriptive statistics were used to analyse responses. Results: Of 211 respondents, 103 (49%) report referring to PR < monthly or not at all. Identified enablers aligned with TDF domains on knowledge and skills. Most PHPs believed referral is easy (129; 61.1%) and (160; 75.9%) agreed to knowing PR programme content. Major barriers related to optimism (only 49 (23.6%) consider patients motivated) and (93; 44.1% believed patients in work are unable to attend). Barriers were also evident in domains social influences (44; 21.1%), report providers rarely engage & goals, (40; 18.9%) PHPs report in-practice measures to improve referral rates are rare. Conclusion: PR referral is infrequent. Knowledge and skills are evident, but interventions to overcome barriers; PHP perceptions of patient, provider engagement and improve goal focus are needed

ranacapa: An R package and Shiny web app to explore environmental DNA data with exploratory statistics and interactive visualizations.

Environmental DNA (eDNA) metabarcoding is becoming a core tool in ecology and conservation biology, and is being used in a growing number of education, biodiversity monitoring, and public outreach programs in which professional research scientists engage community partners in primary research. Results from eDNA analyses can engage and educate natural resource managers, students, community scientists, and naturalists, but without significant training in bioinformatics, it can be difficult for this diverse audience to interact with eDNA results. Here we present the R package ranacapa, at the core of which is a Shiny web app that helps perform exploratory biodiversity analyses and visualizations of eDNA results. The app requires a taxonomy-by-sample matrix and a simple metadata file with descriptive information about each sample. The app enables users to explore the data with interactive figures and presents results from simple community ecology analyses. We demonstrate the value of ranacapa to two groups of community partners engaging with eDNA metabarcoding results

Costs of preparing to implement a virtual reality job interview training programme in a community mental health agency: A budget impact analysis

Rational, aims and objectivesIndividual Placement and Support (IPS) is an evidence based strategy for facilitating employment among adults with severe mental illness (SMI) where staff may lead mock job interviews to prepare clients for real- world interviews (a method with limited scalability and cost effectiveness). A virtual reality job interview training program (VR- JIT)- delivered via the internet- has demonstrated efficacy for increasing employment among adults with SMI. Now, VR- JIT is being implemented with a community mental health agency (CMHA) and evaluated for its effectiveness within IPS. This study is a budget impact analysis, evaluating the costs of preparing a CMHA to implement VR- JIT.MethodImplementation preparation occurred over 7 months from October 1, 2016 to April 30, 2017. CMHA staff (n- =- 15) and external research partners (n- =- 3) tracked their hours completing implementation preparation activities. Salaries plus a 28% fringe benefit rate were used to derive a per- hour salary amount for each individual and applied to each activity. Non- labor equipment costs were obtained from purchase receipts. A budget impact analysis evaluated the expenditures associated with preparing the CMHA to implement VRJIT.ResultsThe total implementation preparation costs equaled $25,482. Labor costs equaled$22,882 and non- labor costs equaled $2,600. In total, 655 person- hours were spent preparing for VR- JIT implementation (e.g., preparing lab space, training, and supervising operations).ConclusionsThis study presents an initial evaluation of the budget impact of preparing to implement VR- JIT in a CMHA. Cost considerations for future implementation preparation will be discussed. Given that the cost to prepare to implement an intervention can hinder its adoption, results provide an important analysis for decision- makers that may enhance uptake. Future work will determine the cost- effectiveness of VR- JIT implemented within IPS. This study is registered at http://clinicaltrials.gov, NCT- =- 03049813, - Virtual Reality Job Interview Training: An Enhancement to Supported Employment in Severe Mental Illness.-Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156238/2/jep13292.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156238/1/jep13292_am.pd