Improving First Case Starts for a Neurosurgery OR

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction. Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%. Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide for neurosurgical procedures was created for placement required equipment and bed. Testing was from September 2-23, 2021, and the visual guide was presented to staff on October 12, 2021. Measures: On-time to the OR is 7:45 a.m. or earlier. The delay minutes and reasons were tracked. The worksheet was a yes/no form confirming if the room had the case cart, equipment, and bed made each morning. Results: August 2021 delay minutes totaled 279, September total was 259, with an improvement of 7.2%. October total was 189 minutes, with an improvement of 32.3%. Overall, surgeon-related delays led the cause for not achieving first case on-time starts; OR-related delays decreased. Conclusion: Identifying the causes of late on-time starts is key to changing practice and to improving metrics. Deeper dives can help streamline and standardize care for the patients. Staff and leadership buy-in is needed for success

Simulation of activation and propagation delay during tripolar neural stimulation

Computer simulations were perfonned to investigate the influence of stimulus amplitude on cathodal activation delay, propagation delay and blocking during stimulation with a bipolar cuff electrode. Activation and propagation delays were combined in a total delay term which was minimized between the excitation and blocking thresholds

Oracy to Literacy: How Can Speech-Language Pathologists in the Schools Collaborate with Teachers Regarding Literacy?

The concept of a connection between oral language and literacy is not new. However, prior to the 1990s, this relationship was not given the substantial credit it deserves (Butler, 1999). In attempt to describe this connection, the term “oracy” has been created. The word “oracy” encapsulates the concept of oral communication and comprehension as building the foundation for literacy. Recent research has brought the significance of this idea to the attention of those involved in literacy in the schools. As a result of changes in our understanding of how children become literate, professionals involved in literacy must adapt to broadened roles and expectations. Speech-language pathologists (SLPs) are among the professionals most impacted by this current focus on the oral language basis for later literacy skills. As research evolves and gains further support, SLPs are called to expand their roles in the schools to include the area of literacy

Everybody S***s: how defecation stigma reduces care quality in dementia

Purpose: This paper aims to raise awareness of the ways in which faecal incontinence can impact the provision of dementia care by examining this through the lens of stigma. Design/methodology/approach: This paper contains a scoping review of available literature relating to faecal incontinence, dementia and stigma. Findings: Literature was organised into three themes: the origins of the stigma, the purpose of stigma and the care context. Research limitations/implications: Limitations of this paper include the lack of literature discussing faecal incontinence and dementia in relation to stigma. Practical implications: Stigma regarding faecal incontinence has the potential to impact quality of life of people with a dementia and contributes towards the invisible work of unqualified care workers. Originality/value: Stigma and faecal incontinence have only a small amount of research around them in residential dementia care

Jumping Ship - Skirting Empire: Indians, Aborigines and Australians across the Indian Ocean

Relationships between South Asians and Australians during the colonial period have been little investigated. Closer attention to the dramatically expanded sea trade after 1850 and the relatively uncontrolled movement of people, ideas and goods which occurred on them, despite claims of imperial regulation, suggests that significant numbers of Indians among others entered Australia outside the immigration restrictions of empire or settlers. Given that many of them entered or remained in Australia without official sanction, their histories will not be found in the official immigration records, but rather in the memories and momentos of the communities into which they might have moved. Exploring the histories of Aboriginal communities and of maritime working class networks does allow a previously unwritten history to emerge: not only of Indian individuals with complex personal and working histories, but often as activists in the campaigns against racial discrimination and in support of decolonization. Yet their heritage has been obscured. The polarizing conflict between settlers and Aboriginal Australians has invariably meant that Aboriginal people of mixed background had to `choose sides to be counted simplistically as either `black or `white. The need to defend the communitys rights has meant that Aboriginal people had to be unequivocal in their identification and this simplification has had to take precedence over the assertion of a diverse heritage. In working class histories, the mobilization of selective ethnic stereotyping has meant that the history of Indians as workers, as unionists and as activists has been distorted and ignored

Synthesizing Datasets to Estimate Terrestrial Water Storage Trends in South Carolina from 1998-2007

2010 S.C. Water Resources Conference - Science and Policy Challenges for a Sustainable Futur

Applying Drought Analysis in the Variable Infiltration Capacity (VIC) Model for South Carolina

2012 S.C. Water Resources Conference - Exploring Opportunities for Collaborative Water Research, Policy and Managemen

A randomized trial of brief intervention strategies in patients with alcohol-related facial trauma as a result of interpersonal violence

Facial trauma is associated with male gender, low socioeconomic status, alcohol misuse, and violence. Brief intervention (BI) for alcohol is effective at reducing consumption in patients presenting with facial trauma. Singlesession control of violence for angry impulsive drinkers(SS-COVAID) is a new intervention that attempts to address alcohol-related violence. This study assessed the effect of SS-COVAID and BI on drinking and aggression in facial trauma patients. Male facial trauma patients who sustained their injuries as a result of interpersonal violence while drinking and who had Alcohol Use Disorders Identification Test (AUDIT) scores of ≥8 were randomized to either BI or SS-COVAID. Patients were followed up at six and 12 months, and drinking and aggression outcomes were analyzed. One hundred ninety-nine patients entered the trial, and 187 were included in the analysis. Of these, 165 (89%) considered themselves to be victims, 92 (51%) had sustained a previous alcohol-related injury, and 28 (15%) had previous convictions for violence. Both interventions resulted in a significant decrease in negative drinking outcomes over 12 months of follow-up (p<0.001). Neither intervention had a significant effect on aggression scores, nor was there a significant difference between interventions in terms of either outcome. Both SS-COVAID and BI had a significant effect on drinking variables in this patient cohort. No effect on aggressionwas seen despite the fact that SS-COVAID specifically addresses the relationship between alcohol and violence. One reason for this may be that the facial trauma patients in this study considered themselves to be victims rather than aggressors. Another possibility is that, while BI may successfully address lifestyle factors such as hazardous or harmful drinking, it may not be effective in modifying personality traits such as aggression

Animal movement modelling: Independent or dependent models?

Hidden Markov models have become a popular time series method for the analysis of GPS tracked animals. Their advantage for identifying latent behavioural states compared with Independent Mixture models is that they take into account the time series dependency of successive displacement distances by the tracked animals. However, little is known about how the analysis results may differ depending on which of these approaches is used. We compared the results and interpretations obtained from fitting Hidden Markov and Independent Mixture models to simulated movement data as well as to field data recording the hourly movements of sable antelope and buffalo within the Kruger National Park, South Africa. Hidden Markov models consistently yielded narrower confidence intervals around parameters and smaller standard errors than simpler time independent mixture models, but for some data the improvement was marginal and the Independent Mixture model provided an adequate alternative for identifying the latent behavioural states of the animal. In general, it is expected Hidden Markov models will provide the better balance between model complexity and extensibility for animal movement modelling from a statistical perspective. However, in some cases, Independent Mixture models could provide an adequate alternative method and might be more faithful biologically