Patient Safety. From Metaphor to Model: The Clarian Safe Passage Program

The most important stakeholders in patient safety are alert and mobilized frontline health care staff. At Clarian Health Partners, Indianapolis, IN, clinicians in the Safe Passage Program work jointly with unit staff, physicians, and other departments to continuously improve the level of patient, employee, and visitor safety. Medical error reporting at Clarian has tripled. The enthusiasm and passion of Safe Passage clinicians is both inspiring and energizing

The Power of Collaboration With Patient Safety Programs: Building Safe Passage for Patients, Nurses, and Clinical Staff

Patient safety is a relatively new field, with many opinions and few effectively proven approaches. One factor is clear: optimal patient safety outcomes cannot be achieved in isolation. Although it is well recognized that multidisciplinary collaboration in the healthcare setting is necessary to effect patient safety, collaboration with resources external to healthcare-academia and industry in particular-will not only aid but also quicken the patient safety efforts. The authors outline a healthcare system\u27s use of all available resources to build a patient safety program

Meningeal Infiltration of the Spinal Cord by Non-Classically Activated B Cells is Associated with Chronic Disease Course in a Spontaneous B Cell-Dependent Model of CNS Autoimmune Disease

We characterized B cell infiltration of the spinal cord in a B cell-dependent spontaneous model of central nervous system (CNS) autoimmunity that develops in a proportion of mice with mutant T and B cell receptors specific for myelin oligodendrocyte glycoprotein. We found that, while males are more likely to develop disease, females are more likely to have a chronic rather than monophasic disease course. B cell infiltration of the spinal cord was investigated by histology and FACs. CD4+ T cell infiltration was pervasive throughout the white and in some cases gray matter. B cells were almost exclusively restricted to the meninges, often in clusters reminiscent of those described in human multiple sclerosis. These clusters were typically found adjacent to white matter lesions and their presence was associated with a chronic disease course. Extensive investigation of these clusters by histology did not identify features of lymphoid follicles, including organization of T and B cells into separate zones, CD35+ follicular dendritic cells, or germinal centers. The majority of cluster B cells were IgD+ with little evidence of class switch. Consistent with this, B cells isolated from the spinal cord were of the naïve/memory CD38hi CD95lo phenotype. Nevertheless, they were CD62Llo and CD80hi compared to lymph node B cells suggesting that they were at least partly activated and primed to present antigen. Therefore, if meningeal B cells contribute to CNS pathology in autoimmunity, follicular differentiation is not necessary for the pathogenic mechanism

Coastal ecosystem investigations with LiDAR (light detection and ranging) and bottom reflectance: Lake Superior reef threatened by migrating tailings

Where light penetration is excellent, the combination of LiDAR (Light Detection And Ranging) and passive bottom reflectance (multispectral, hyperspectral) greatly aids environmental studies. Over a century ago, two stamp mills (Mohawk and Wolverine) released 22.7 million metric tons of copper-rich tailings into Grand Traverse Bay (Lake Superior). The tailings are crushed basalt, with low albedo and spectral signatures different from natural bedrock (Jacobsville Sandstone) and bedrock-derived quartz sands. Multiple Lidar (CHARTS and CZMIL) over-flights between 2008–2016—complemented by ground-truth (Ponar sediment sampling, ROV photography) and passive bottom reflectance studies (3-band NAIP; 13-band Sentinal-2 orbital satellite; 48 and 288-band CASI)—clarified shoreline and underwater details of tailings migrations. Underwater, the tailings are moving onto Buffalo Reef, a major breeding site important for commercial and recreational lake trout and lake whitefish production (32% of the commercial catch in Keweenaw Bay, 22% in southern Lake Superior). If nothing is done, LiDAR-assisted hydrodynamic modeling predicts 60% tailings cover of Buffalo Reef within 10 years. Bottom reflectance studies confirmed stamp sand encroachment into cobble beds in shallow (0-5m) water but had difficulties in deeper waters (\u3e8 m). Two substrate end-members (sand particles) showed extensive mixing but were handled by CASI hyperspectral imaging. Bottom reflectance studies suggested 25-35% tailings cover of Buffalo Reef, comparable to estimates from independent counts of mixed sand particles (ca. 35% cover of Buffalo Reef by \u3e20% stamp sand mixtures)

A plague of waterfleas (Bythotrephes): impacts on microcrustacean community structure, seasonal biomass, and secondary production in a large inland-lake complex

© 2016, The Author(s). The spiny cladoceran (Bythotrephes longimanus) is an invasive, predaceous zooplankter that is expanding from Great Lakes coastal waters into inland lakes within a northern latitudinal band. In a large, Boundary Water lake complex (largely within Voyageurs National Park), we use two comparisons, a 2-year spatial and a 12-year temporal, to quantify seasonal impacts on food webs and biomass, plus a preliminary calculation of secondary production decline. Bythotrephes alters the seasonal biomass pattern by severely depressing microcrustaceans during summer and early fall, when the predator is most abundant. Cladoceran and cyclopoid copepods suffer the most serious population declines, although the resistant cladoceran Holopedium is favored in spatial comparisons. Microcrustacean biomass is reduced 40–60 % and secondary production declines by about 67 %. The microcrustacean community shifts towards calanoid copepods. The decline in secondary production is due both to summer biomass loss and to the longer generation times of calanoid copepods (slower turnover). The Bythotrephes “top-down” perturbation appears to hold across small, intermediate, and large-sized lakes (i.e. appears scale-independent), and is pronounced when Bythotrephes densities reach 20–40 individuals L−1. Induction tests with small cladocerans (Bosmina) suggest that certain native prey populations do not sense the exotic predator and are “blind-sided”. Failure of prey to deploy defenses could explain the disproportionate community impacts in New World versus Old World lakes

Longer-term effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: An extended follow up of pragmatic randomised controlled trial

Background: Self-harm in adolescents is common and repetition frequent. Evidence for effective interventions to reduce self-harm is limited. Long term follow-up of existing studies is rare. Methods: Extended follow up, from 18 to at least 36-months, of the SHIFT trial: a pragmatic, multi-centre, individually-randomised, controlled trial involving young people (11–17) who had self-harmed at least twice and presented to Child & Adolescent Mental Health Services (CAMHS). SHIFT evaluated manualised family therapy (FT) versus treatment as usual (TAU) in reducing repetition of self-harm leading to hospital attendance 18 months post-randomisation. We obtained ONS mortality data, adult mental health data, and further details of hospital attendance from routine Hospital Episode Statistics (HES) data plus researcher follow-up. We assessed longer-term differences in outcome using multivariable Cox Proportional Hazards regression analysis, and assessed all-cause mortality and morbidity relating to hospital attendances for reasons other than self-harm. Study registration: ISRCTN 59793150 Outcomes: The original sample of 832 were randomised between April 2010 and December 2013. Extended follow-up continued until February 2017 for a median 55·4 months (range 0–82·5 months), providing post 18-month data for 804 (96·6%) participants, of whom 785 (94·4%) had a minimum of 36-months follow-up. There was no evidence of a between-group difference in the primary outcome during the extended follow-up period (Hazard Ratio (HR) 1·03; 95% CI: 0·83, 1·28; p-value=0·78), consistent with our findings in the original trial with 18 months follow-up (HR 1·14, 95% CI 0·87, 1·49; p-value 0·33). There was a reduced rate of self-harm in older participants aged 15–17 (HR 0·7, 95% CI 0·56, 0·88), as compared with those aged 11–14; and significantly increased rates of self-harm in participants whose index episode combined self-injury and poisoning (HR 1·8, 95% CI 1·2, 2·7). Two deaths were reported during the extended follow up period. Interpretation: For adolescents referred to CAMHS after self-harm, having self-harmed at least once before, trial FT confers no benefits over TAU in reducing subsequent hospitalisation for self-harm over 18 months or 36 months. Funding: NIHR HTA Reference: 07/33/0

Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation

Objective To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people

Employability and higher education: contextualising female students' workplace experiences to enhance understanding of employability development

Current political and economic discourses position employability as a responsibility of higher education, which deploys mechanisms such as supervised work experience (SWE) to embed employability skills development into the undergraduate curriculum. However, workplaces are socially constructed complex arenas of embodied knowledge that are gendered. Understanding the usefulness of SWE therefore requires consideration of the contextualised experiences of it, within these complex environments. This study considers higher education's use of SWE as a mechanism of employability skills development through exploration of female students' experiences of accounting SWE, and its subsequent shaping of their views of employment. Findings suggest that women experience numerous, indirect gender-based inequalities within their accounting SWE about which higher education is silent, perpetuating the framing of employability as a set of individual skills and abilities. This may limit the potential of SWE to provide equality of employability development. The study concludes by briefly considering how insights provided by this research could better inform higher education's engagement with SWE within the employability discourse, and contribute to equality of employability development opportunity

Prelimbic and infralimbic cortical regions differentially encode cocaine-associated stimuli and cocaine-seeking before and following abstinence

Cocaine stimuli often trigger relapse of drug-taking, even following periods of prolonged abstinence. Here, electrophysiological recordings were made in rats (n = 29) to determine how neurons in the prelimbic (PrL) or infralimbic (IL) regions of the medial prefrontal cortex (mPFC) encode cocaine-associated stimuli and cocaine-seeking, and whether this processing is differentially altered after 1 month of cocaine abstinence. After self-administration training, neurons (n=308) in the mPFC were recorded during a single test session conducted either the next day or 1 month later. Test sessions consisted of three phases during which (i) the tone–houselight stimulus previously paired with cocaine infusion during self-administration was randomly presented by the experimenter, (ii) rats responded on the lever previously associated with cocaine during extinction and (iii) the tone–houselight was presented randomly between cocaine-reinforced responding during resumption of cocaine self-administration. PrL neurons showed enhanced encoding of the cocaine stimulus and drug-seeking behavior (under extinction and self-administration) following 30 days of abstinence. In contrast, although IL neurons encoded cocaine cues and cocaine-seeking, there were no pronounced changes in IL responsiveness following 30 days’ abstinence. Importantly, cue-related changes do not represent a generalized stimulus-evoked discharge as PrL and IL neurons in control animals (n=4) exhibited negligible recruitment by the tone–houselight stimulus. The results support the view that, following abstinence, neural encoding in the PrL but not IL may play a key role in enhanced cocaine-seeking, particularly following re-exposure to cocaine-associated cues