Expertise: Novice Approach vs. Expert Strategy

Humans have been fascinated with a job well done since the beginning of time. We extol our heroes. Those that triumph with skill and prowess we can’t imagine possessing get passionate songs and epic poems written about them. We lift them high with our awe and place them on pedestals. We spend big bucks to see their concerts and faint when they pass near us in the crowd. We give them millions of dollars to bounce balls for a living and buy whatever soda is their favorite. We give them Nobel Prizes and save their brains in jars so 3rd year graduate students can perform experiments 60 years later. Experts are fascinating

Adaptive Mobility for the Visually Impaired: Exploring what the Future of Social Mobility Could Look Like for the Visually Impaired Community (Development Log)

Our project is primarily a technology-push product, in which we leveraged the advantages of an existence technology called proximity sensor. The team focused on utilizing and matching the appropriate application of the technology with the market needs. Since the technology is proven, the possibility of risks substantially reduced. The first phase, called “phase zero,” is to identify the opportunity by exploring the market necessities. Our team conducted various types of research to understand the market needs. With personal motives, the team showed the interests to assist the visually impaired community for the freedom and independence with their physical activities

Forecasting Super-Efficient Dryers Adoption in the Pacific Northwest

Energy efficiency is now estimated to be the third source of electricity in the USA (in the form of virtual power capacity equal to the savings resulted from efficiency). The Pacific NorthWest is among the leading regions in the US when it comes to energy efficiency [1, 2], in fact, it is estimated that energy efficiency will meet all the new demands in the Pacific NorthWest region through 2035. The Northwest Energy Efficiency Alliance (NEEA), is an alliance of more than 140 Northwest utilities and energy efficiency organizations, dedicated to accelerating both electric and gas energy efficiency, leveraging its regional partnerships to advance the adoption of energy-efficient products, services and practices. One product NEEA has been evaluating recently is super-efficient dryers, a product that promises energy efficiency as much as 40% of the current energy being consumed by a typical dryer in the region [4]. Before NEEA can promote and support this product, they need to understand its market potentials, so two separated studies were conducted to forecast this product future, however; the studies indicated different results. In this project, the objectives are to forecast the adoption and market share of super-efficient dryers (SED’s) and to provide additional information that could help organizations like NEEA to promote and disseminate SED’s, creating market transformations towards the adoption of energy efficient products. More specifically, our goal is to help NEEA by providing them with yet another counter-factual model of the super efficient dryers adoption (focusing on a specific market segment), and also to enable NEEA to use this model as a tool to convince manufacturers to increase their marketing efforts towards a larger adoption. The next section brings a literature review on technology forecasting, energy efficiency and other important topics for this study, followed by methodology, analysis and results, conclusions, limitations and future research

Wearable Technology: Diabetes Monitoring in the Healthcare Industry

The health industry is truly blossoming with promise as wearables, biofeedback, and digital health tracking is gaining sophistication and popularity, with far reaching implications for patients and medical professionals. Historically, these sorts of medical devices could be used for treatment for phantom limbs [1], physical therapy [2], pain management [3], attention [4], incontinence [5], and sleep disorders [6]. Very recently, in the past few years there has been an outpouring of increased interest and availability of more modern, advanced, and accessible wearable devices. Truly, we are witnessing the dawn of wearable computers. Diabetes is a serious medical condition that affects around 20% of Americans, and that number increases every year. It is the 7th leading cause of death in the US, and comes with a bevy of comorbid conditions like stroke, blindness, kidney disease, and amputations. It also comes with a hefty $245 billion medical treatment cost each year [9]. This does mean, however, that there is a huge and hungry market needing better, more accurate treatment and constant data collection for medical providers. This case will report of the brightest technologies available currently, and we’ll assess their value to the market to predict which should be adopted for the most impact

Cardiopulmonary resuscitation in adults over 80 : outcome and the perception of appropriateness by clinicians

OBJECTIVES: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN: Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING: Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS: A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS: The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION: Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 201

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London