Failure of an Educational Intervention to Improve Consultation and Implications for Healthcare Consultation.

INTRODUCTION: Consultation of another physician for his or her specialized expertise regarding a patient's care is a common occurrence in most physicians' daily practice, especially in the emergency department (ED). Therefore, the ability to communicate effectively with another physician during a patient consultation is an essential skill. However, there has been limited research on a standardized method for a physician to physician consultation with little guidance on teaching consultations to physicians in training. The objective of our study was to measure the effect of a structured consultation intervention on both content standardization and quality of medical student consultations. METHODS: Senior medical students were assessed on a required emergency medicine rotation with a physician phone consultation during a standardized, simulated chest pain case. The intervention groups received a standard consult checklist as part of their orientation to the rotation, followed by a video recording of a good consult call and a bad consult call with commentary from an emergency physician. The intervention was given to students every other month, alternating with a control group who received no additional education. Recordings were reviewed by three second-year internal medicine residents pursuing a fellowship in cardiology. Each recording was evaluated by two of the three reviewers and scored using a standardized checklist. RESULTS: Providing a standardized consultation intervention did not improve students' ability to communicate with consultants. In addition, there was variability between evaluators in regards to how they received the same information and how they perceived the quality of the same recorded consultation calls. Evaluator inter-rater reliability (IRR) was poor on the questions of 1) would you have any other questions of the student calling the consult and 2) did the student calling the consult provide an accurate account of information and case detail. The IRR was also poor on objective data such as whether the student stated their name. CONCLUSIONS: A brief intervention may not be enough to change complex behavior such as a physician to physician consultant communication. Importantly, despite consultants listening to the same audio recordings, the information was processed differently. Future investigations should focus on both those delivering as well as those receiving a consultation

Utilizing Tranexamic Acid To Reduce Blood Transfusion In Hip Fractures

Minimizing perioperative blood loss during orthopedic surgery has proven challenging for providers. Perioperative utilization of antifibrinolytic pharmacologic interventions, such as tranexamic acid (TXA), has been demonstrated as a safe and effective technique for decreasing blood loss and allogenic blood transfusion rates. Currently, the Food and Drug Administration (FDA) approved on-label indications of TXA are for use in short-term treatment of hemophilia patients undergoing dental extractions and in management of patients experiencing menorrhagia (Mayeux, Alwon, Collins, & Hewer, 2016). Despite the current limited scope of FDA approval for TXA, use in elective surgery with otherwise clotting-uncompromised patients is not a new concept. Perioperative TXA administration in elective joint replacement surgery, cardiopulmonary bypass, spinal fusions, and hysterectomies has been well studied (Duncan et al., 2015). Numerous studies have acknowledged TXA use decreases perioperative blood loss, decreases perioperative blood transfusions, and shortens length of hospital stay. Additionally, research exists that demonstrates safety and efficacy of TXA use in patients presenting with traumatic injury (Roberts et al., 2013). Despite this vast body of knowledge, little research exists evaluating TXA use in hip fractures. Over 325,000 traumatic hip fractures occur every year (Neuman, Rosenbaum, Ludwig, Zubizarreta, & Silber, 2014). This patient population is generally frail and typically lacks optimization prior to urgent surgery. Based on the extensive body of prior research conducted to date, it is reasonable to postulate that TXA use in these instances would yield a decreased blood loss and therefore contribute to lower rates of allogenic blood transfusion in hip fracture patients

Full Scale Alternative Catalyst Testing for Bosch Reactor Optimization

Current air revitalization technology onboard the International Space Station (ISS) cannot provide complete closure of the oxygen and hydrogen loops. This makes re-supply necessary, which is possible for missions in low Earth orbit (LEO) like the ISS, but unviable for long term space missions outside LEO. In comparison, Bosch technology reduces carbon dioxide with hydrogen, traditionally over a steel wool catalyst, to create water and solid carbon. The Bosch product water can then be fed to the oxygen generation assembly to produce oxygen for crew members and hydrogen necessary to reduce more carbon dioxide. Bosch technology can achieve complete oxygen loop closure, but has many undesirable factors that result in a high energy, mass, and volume system. Finding a different catalyst with an equal reaction rate at lower temperatures with less catalyst mass and longer lifespan would make a Bosch flight system more feasible. Developmental testing of alternative catalysts for the Bosch has been performed using the Horizontal Bosch Test Stand. Nickel foam, nickel shavings, and cobalt shavings were tested at 500 C and compared to the original catalyst, steel wool. This paper presents data and analysis on the performance of each catalyst tested at comparable temperatures and recycle flow rates

Input and Processing Factors Affecting Infants’ Vocabulary Size at 19 and 25 Months

This study examined the relative contributions of three factors to individual differences in vocabulary development: the acoustic quality of mothers’ speech, the quantity of mothers’ speech, and infants’ ability to recognize words. To examine the quality and quantity of mothers’ speech, recordings were collected from 48 mothers when their infants were 17 months old. Infants’ ability to recognize words was gauged by their performance in a perception experiment at 19 months. We examined the relationship between these measures and infants’ vocabulary size at 19 and 25 months. The quantity of mothers’ speech accounted for the greatest amount of variance in infants’ vocabulary size at 19 months; infants’ ability to recognize words followed next. At 25 months, when mothers’ speech alone is presumably no longer the primary input for infants, infants’ ability to recognize words at 19 months was a better predictor of vocabulary size. The acoustic quality of mothers’ speech was not correlated with infants’ vocabulary size at either age. The findings highlight the importance of considering multiple factors that contribute to early word learning, providing a better understanding of the mechanisms underlying the facilitation process

Evaluation of Sorbents for Acetylene Separation in Atmosphere Revitalization Loop Closure

State-of-the-art carbon dioxide reduction technology uses a Sabatier reactor to recover water from metabolic carbon dioxide. In order to maximize oxygen loop closure, a byproduct of the system, methane, must be reduced to recover hydrogen. NASA is currently exploring a microwave plasma methane pyrolysis system for this purpose. The resulting product stream of this technology includes unreacted methane, product hydrogen, and acetylene. The hydrogen and the small amount of unreacted methane resulting from the pyrolysis process can be returned to the Sabatier reactor thereby substantially improving the overall efficiency of the system. However, the acetylene is a waste product that must be removed from the pyrolysis product. Two materials have been identified as potential sorbents for acetylene removal: zeolite 4A, a commonly available commercial sorbent, and HKUST-1, a newly developed microporous metal. This paper provides an explanation of the rationale behind acetylene removal and the results of separation testing with both material

Urban Intersections: Engaging Dualities in Shanghai

The absolute polarization of contextual and tabula rasa urban models has long been advanced, even blatantly promoted, within the discipline. Taken for granted as foils, the exclusive championing and application of context or tabula rasa has only served to undermine the agency of the contemporary city. Producing an ineffectual and one-dimensional duality, cities have been reduced to futilely choose between the old and the new. A city of contradictory extremes, the clash between these concepts is embodied in the urbanism of Shanghai. With the impetus of China’s “Economic Miracle,” a previously unheard of scale and speed of urbanization has been achieved throughout the country with the creation of “instant cities.” Embraced as testing grounds for contemporary urbanism, the characteristics and conditions of the instant cities have been enthusiastically and almost universally adopted, leading to a primacy of tabula rasa and vertical development. Partially transformed by this model of erasure, Shanghai’s urbanism is defined by confrontation as the urban models of the past and present collide. The duality manifest by this conflict compels an examination of the seemingly agonistic roles of context and erasure in the city. The ambition of this thesis is to eliminate such distinctions; the choice between contextual and tabula rasa approaches does not work. This false choice produces either a conservative preservationist tourist attraction or a generic and totalizing vertical city. The shallow tendencies of both approaches threaten the city as a multiple and collective space of possibility. By adopting a broader view of context and collapsing present dualities, this project seeks to create complexity and new confrontations through an urban morphology shaped by architecture. Moving beyond contextual preservation and tabula rasa, this thesis seeks to engage and create another reality using that juxtaposition to open new relationships within the city