Impact of Scribes with Flow Coordination Duties on Throughput in an Academic Emergency Department

Introduction: With the increasing influence of electronic health records in emergency medicine came concerns of decreasing operational efficiencies. Particularly worrisome was increasing patient length of stay (LOS). Medical scribes were identified to be in a good position to quickly address barriers to treatment delivery and patient flow. The objective of this study was to investigate patient LOS in the mid- and low-acuity zones of an academic emergency department (ED) with and without medical scribes.Methods: A retrospective cohort study compared patient volume and average LOS between a cohort without scribes and a cohort after the implementation of a scribe-flow coordinator program. Patients were triaged to the mid-acuity Vertical Zone (primarily Emergency Severity Index [ESI] 3) or low-acuity Fast Track (primarily ESI 4 and 5) at a tertiary academic ED. Patients were stratified by treatment zone, acuity level, and disposition.Results: The pre-intervention and post-intervention periods included 8900 patients and 9935 patients, respectively. LOS for patients discharged from the Vertical Zone decreased by 12 minutes from 235 to 223 minutes (p<0.0001, 95% confidence interval [CI], -17,-7) despite a 10% increase in patient volume. For patients admitted from the Vertical Zone, volume increased 13% and LOS remained almost the same, increasing from 225 to 228 minutes (p=0.532, 95% CI, -6,12). For patients discharged from the Fast Track, volume increased 14% and LOS increased six minutes, from 89 to 95 minutes (p<0.0001, 95% CI, 4,9). Predictably, only 1% of Fast Track patients were admitted.Conclusion: Despite substantially increased volume, the use of scribes as patient flow facilitators in the mid-acuity zone was associated with decreased LOS. In the low-acuity zone, scribes were not shown to be as effective, perhaps because rapid patient turnover required them to focus on documentation

Explaining anomalies in SAR and scatterometer soil moisture retrievals from dry soils with sub-surface scattering

This paper presents the results of a laboratory investigation to explain anomalously-high soil moisture estimates observed in retrievals from SAR and scatterometer backscatter, affecting extensive areas of the world associated with arid climates. High resolution C-band tomographic profiling was applied in experiments to understand the mechanisms underlying these anomalous retrievals. The imagery captured unique high-resolution profiles of the variations in the vertical backscattering patterns though a sandy soil with moisture change. The relative strengths of the surface and sub-surface returns were dependent upon both soil moisture and soil structure, incidence-angle, and polarization. Co-polarised returns could be dominated by both surface and sub-surface returns at times, whereas cross-polarised returns were strongly associated with sub-surface features. The work confirms suspicions that anomalous moisture estimates can arise from the presence of sub-surface features. Diversity in polarization and incidence angle may provide sufficient diagnostics to flag and correct these erroneous estimates, allowing their incorporation into global soil moisture productsMorriso

RESEARCH BRIEF: An Examination of the Social and Clinical Influences in Prostate Cancer Treatment in African American and White Men

BACKGROUND: The death rate for prostate cancer (PrCA), the most commonly diagnosed cancer in African-American (AA) men, is twice the rate of European-American (EA) men. AA men in South Carolina have the highest age-adjusted death rate in the nation. Studies have shown that treatment offered to AA men with PrCA is systematically different from that offered to EA men. METHODS: Surveys were mailed to 1,866 men in South Carolina with a diagnosis of PrCA. South Carolina men diagnosed with PrCA between 1996 and 2002 were eligible to participate. We performed a descriptive assessment of the factors that influenced PrCA treatment decisions. RESULTS: The treatment choices of AA men were significantly more likely to be influenced by pain and significantly less likely to be influenced by potential for cure compared to EA men. CONCLUSIONS: Providers must be cognizant of the factors that influence treatment, particularly in AA men. Despite the national undertaking to eliminate health disparities, the United States is far from implementing a comprehensive focus on the health of AA men, despite their elevated PrCA morbidity and mortality rates

China's iGeneration

Collection of essays on twenty-first century Chinese cinema and moving image culture. This innovative collection of essays on twenty-first century Chinese cinema and moving image culture features contributions from an international community of scholars, critics, and practitioners. Taken together, their perspectives make a compelling case that the past decade has witnessed a radical transformation of conventional notions of cinema. Following China's accession to the WTO in 2001, personal and collective experiences of changing social conditions have added new dimensions to the increasingly diverse Sinophone media landscape, and provided a novel complement to the existing edifice of blockbusters, documentaries, and auteur culture. The numerous 'iGeneration' productions and practices examined in this volume include 3D and IMAX films, experimental documentaries, animation, visual aides-mémoires, and works of pirated pastiche

Soil moisture and soil depth retrieval using the coupled phase-amplitude behaviour of C-band radar backscatter in the presence of sub-surface scattering

In low-moisture regimes, strongly-reflecting bedrock underlying a soil could provide a dominant return. This offers a novel opportunity to retrieve both the volumetric moisture fraction (mv) and depth (d) of a soil layer using differential phase. A radar wave traversing the overlying soil slows in response to moisture state; moisture dynamics are thus recorded as variations in travel time - captured back at a radar platform as changes in phase. The Phase Scaled Dielectric (PSD) model introduced here converts phase changes to those in soil dielectric as an intermediate step to estimating mv. Simulations utilising a real soil moisture timeseries from a site in Sudan were used to demonstrate the linked behaviours of the soil and radar variables, and detail the PSD principle. A laboratory validation used a soil with a wet top layer variable in depth 1-2 cm and drying from mv~0.2 m3m-3, overlying a gravel layer at a depth of 11 cm. The scheme retrieved d=1.49 ± 0.33 cm and a change Δmv = 0.191-0.021 ± 0.009 m3m-3. The PSD scheme outlined here promises a new avenue for the diagnostic measurement of soil parameters which is not currently available to radar remote sensing. Dans les conditions de faible humidité, un substratum rocheux fortement réfléchissant sous-jacent à un sol pourrait fournir un signal de retour dominant. Cela offre la nouvelle possibilité de récupérer à la fois la fraction d’humidité volumétrique (mv) et la profondeur (d) d’une couche de sol en utilisant la phase différentielle. Une onde radar traversant le sol sus-jacent ralentit en réponse à l’état d’humidité; la dynamique de l’humidité est donc enregistrée sous forme de variations du temps de trajet - capturées sur une plate-forme radar sous forme de changements de phase. Le modèle PSD (Phase Scaled Dielectric) présenté ici convertit les changements de phase en changements de la diélectrique du sol comme une étape intermédiaire de l’estimation de mv. Des simulations utilisant une série chronologique réelle d’humidité du sol provenant d’un site au Soudan ont été utilisées pour démontrer les comportements liés du sol et des variables radar, et détailler le principe de la DSP. Une validation en laboratoire a été réalisée utilisant un sol avec une couche supérieure humide variable de 1 à 2 cm de profondeur et un séchage de mv ∼ 0,2 m3m−3, recouvrant une couche de gravier à une profondeur de 11 cm. Le schéma a récupéré d = 1,49 ± 0,33 cm et un changement Δmv = 0,191–0,021 ± 0,009 m3m−3. Le programme PSD décrit ici promet une nouvelle approche pour la mesure diagnostique des paramètres du sol qui n’est actuellement pas disponible pour la télédétection radar

Social and clinical predictors of prostate cancer treatment decisions among men in South Carolina

OBJECTIVE: To assess social and clinical influences of prostate cancer treatment decisions among white and black men in the Midlands of South Carolina. METHODS: We linked data collected on treatment decision making in men diagnosed with prostate cancer from 1996 through 2002 with clinical and sociodemographic factors collected routinely by the South Carolina Central Cancer Registry (SCCCR). Unconditional logistic regression was used to assess social and clinical influences on treatment decision. RESULTS: A total of 435 men were evaluated. Men of both races who chose surgery (versus radiation) were more likely to be influenced by their physician and by family/friends. Black men who chose surgery also were ~5 times more likely to make independent decisions (i.e., rather than be influenced by their doctor). White men who chose surgery were twice as likely to be influenced by the desire for cure and less likely to consider the side effects of impotence (odds ratio (OR) = 0.40; 95% confidence interval (CI): 0.18, 0.88) and incontinence (OR = 0.27; 95% CI: 0.12, 0.63); by contrast, there was a suggestion of an opposite effect in black men, whose decision regarding surgery tended to be more strongly influenced by these side effects. CONCLUSION: Results suggest that both clinical and social predictors play an important role for men in choosing a prostate cancer treatment, but these influences may differ by race

Cytochrome P450 3A4 and P‐glycoprotein mediate the interaction between an oral erythromycin breath test and rifampin

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109878/1/cptclpt2002114.pd

Three professions come together for an interdisciplinary approach to 3D printing: occupational therapy, biomedical engineering, and medical librarianship

Background: Although many libraries have offered 3D printing as a service or available technology, there is a lack of information on course-integrated programs for 3D printing in which the library played a primary role. Therefore, librarians at the Touro College School of Health Sciences began exploring 3D printing for inclusion in the occupational and physical therapy curriculum. Case Presentation: The goal of this project was to educate occupational and physical therapy students and faculty about the potential applications of 3D printing in health care and provide hands-on experience, while increasing collaboration between librarians and faculty. Students’ tasks included designing and creating a 3D-printed assistive device as part of their course. Conclusion: Students were able to successfully print assistive devices, demonstrating the feasibility of 3D printing in a health sciences curriculum. Librarians involved with this project reached approximately 78 students and 200 other librarians and faculty members. 3D printing at Touro College continues to evolve and expand; the trial 3D printing course is being reviewed for formal adoption into the occupational therapy curriculum, and additional funding for 3D printing technologies is currently being allocated by Touro administration

China's iGeneration

Collection of essays on twenty-first century Chinese cinema and moving image culture. This innovative collection of essays on twenty-first century Chinese cinema and moving image culture features contributions from an international community of scholars, critics, and practitioners. Taken together, their perspectives make a compelling case that the past decade has witnessed a radical transformation of conventional notions of cinema. Following China's accession to the WTO in 2001, personal and collective experiences of changing social conditions have added new dimensions to the increasingly diverse Sinophone media landscape, and provided a novel complement to the existing edifice of blockbusters, documentaries, and auteur culture. The numerous 'iGeneration' productions and practices examined in this volume include 3D and IMAX films, experimental documentaries, animation, visual aides-mémoires, and works of pirated pastiche