Champion Teams as a Mechanism for Developing Team Care Capacity

Practice transformation toward team care as a singular undertaking can be daunting. In this presentation, we describe the development of a mechanism for small, iterative and sustainable practice changes toward team care known as Champion Teams. Champion Teams are based on the Institute of Medicine\u27s learning health care system approach in which practitioners develop an internal mechanism for and culture around digesting and implementing new evidence based practices on an ongoing basis. In addition to presenting the Champion Team concept as a strategy for implementing new team care initiatives, interprofessional providers will present two case examples from each adult and pediatric primary care. At the conclusion of this presentation, participants will be able to: Define the term learning healthcare system and its application to Champion Teams. Describe the utility of and keys to implementing Champion Teams. Describe two examples of Champion Teams and the application of this mechanism to making data-informed changes toward team-based care in their own setting

Eye of horus – Erratum revealed a prescription survey

Background: The aim of this study was to survey the quality and the content of prescription of practitioners and also assess the legibility of alphabet, and short form of the drug.Methods: A survey of all prescription received by the patients that were written by general practitioners, consulting physicians and dentists in and around Virajpet and Madikeri (south Coorg) was included.The prescriptions were photocopied and returned back to the patients. The prescription was scored and analyzed by a qualified medical investigator.Results: A total of 171 prescription samples were collected. In most prescriptions, one or more aspects of patient’s personal details were missing. Concerned doctor’s details also lacked in most cases. 40.3% of the prescriptions were obtained wherein short form of the drug was used for prescribing drug. Legibility of alphabet was also evaluated and the most confusing letter noted in our study was letter “C”; followed by A, T, S, O, G, and D in this study the letter Rx was written in 7% of the prescription and in 19% prescription it was replaced by word “Adv” and 74% of prescription without symbol of Rx.Conclusions: The present data shows most prescriptions in the study was inadequate and important details were lacking, legibility of prescription was poor in rating

A fractional K-BKZ constitutive formulation for describing the nonlinear rheology of multiscale complex fluids

The relaxation processes of a wide variety of soft materials frequently contain one or more broad regions of power-law like or stretched exponential relaxation in time and frequency. Fractional constitutive equations have been shown to be excellent models for capturing the linear viscoelastic behavior of such materials, and their relaxation modulus can be quantitatively described very generally in terms of a Mittag–Leffler function. However, these fractional constitutive models cannot describe the nonlinear behavior of such power-law materials. We use the example of Xanthan gum to show how predictions of nonlinear viscometric properties, such as shear-thinning in the viscosity and in the first normal stress coefficient, can be quantitatively described in terms a nonlinear fractional constitutive model. We adopt an integral K-BKZ framework and suitably modify it for power-law materials exhibiting Mittag–Leffler type relaxation dynamics at small strains. Only one additional parameter is needed to predict nonlinear rheology, which is introduced through an experimentally measured damping function. Empirical rules such as the Cox–Merz rule and Gleissle mirror relations are frequently used to estimate the nonlinear response of complex fluids from linear rheological data. We use the fractional model framework to assess the performance of such heuristic rules and quantify the systematic offsets, or shift factors, that can be observed between experimental data and the predicted nonlinear response. We also demonstrate how an appropriate choice of fractional constitutive model and damping function results in a nonlinear viscoelastic constitutive model that predicts a flow curve identical to the elastic Herschel-Bulkley model. This new constitutive equation satisfies the Rutgers-Delaware rule, which is appropriate for yielding materials. This K-BKZ framework can be used to generate canonical three-element mechanical models that provide nonlinear viscoelastic generalizations of other empirical inelastic models such as the Cross model. In addition to describing nonlinear viscometric responses, we are also able to provide accurate expressions for the linear viscoelastic behavior of complex materials that exhibit strongly shear-thinning Cross-type or Carreau-type flow curves. The findings in this work provide a coherent and quantitative way of translating between the linear and nonlinear rheology of multiscale materials, using a constitutive modeling approach that involves only a few material parameters

Extensional flow of hyaluronic acid solutions in an optimized micofluidic cross-slot device

We utilize a recently developed microfluidic device, the Optimized Shape Cross-slot Extensional Rheometer (OSCER), to study the elongational flow behavior and rheological properties of hyaluronic acid (HA) solutions representative of the synovial fluid (SF) found in the knee joint. The OSCER geometry is a stagnation point device that imposes a planar extensional flow with a homogenous extension rate over a significant length of the inlet and outlet channel axes. Due to the compressive nature of the flow generated along the inlet channels, and the planar elongational flow along the outlet channels, the flow field in the OSCER device can also be considered as representative of the flow field that arises between compressing articular cartilage layers of the knee joints during running or jumping movements. Full-field birefringence microscopy measurements demonstrate a high degree of localized macromolecular orientation along streamlines passing close to the stagnation point of the OSCER device, while micro-particle image velocimetry is used to quantify the flow kinematics. The stress-optical rule is used to assess the local extensional viscosity in the elongating fluid elements as a function of the measured deformation rate. The large limiting values of the dimensionless Trouton ratio, Tr ∼ O(50), demonstrate that these fluids are highly extensional-thickening, providing a clear mechanism for the load-dampening properties of SF. The results also indicate the potential for utilizing the OSCER in screening of physiological SF samples, which will lead to improved understanding of, and therapies for, disease progression in arthritis sufferers

Just married: the synergy between feminist criminology and the Tripartite Cybercrime Framework

This article is a theoretical treatment of feminist epistemology of crime, which advocates the centrality of gender as a theoretical starting point for the investigating of digital crimes. It does so by exploring the synergy between the feminist perspectives and the Tripartite Cybercrime Framework (TCF) (which argues that three possible factors motivate cybercrimes – socioeconomic, psychosocial, and geopolitical) to critique mainstream criminology and the meaning of the term “cybercrime”. Additionally, the article examines gender gaps in online harassment, cyber‐bullying, cyber‐fraud, revenge porn, and cyber‐stalking to demonstrate that who is victimised, why, and to what effect are the critical starting points for the analysis of the connections between gender and crimes. In turn, it uses the lens of intersectionality to acknowledge that, while conceptions of gender and crime interact, they intersect with other categories (e.g., sexuality) to provide additional layers of explanation. To nuance the utilitarian value of the synergy between the TCF and the feminist perspectives, the focus shifts to a recent case study (which compared socioeconomic and psychosocial cybercrimes). The article concludes that, while online and offline lives are inextricably intertwined, the victimisations in psychosocial cybercrimes may be more gendered than in socioeconomic cybercrimes. These contributions align the TCF to the feminist epistemology of crime in their attempt to move gender analysis of digital crimes “from margin to centre”

Use of IFN gamma/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNγ/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNγ and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNγ/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNγ/IL10 may become a suitable theranostic marker for an urging clinical need

PITX1 is a regulator of TERT expression in prostate cancer with prognostic power

Simple Summary Most prostate cancer is of an indolent form and is curable. However, some prostate cancer belongs to rather aggressive subtypes leading to metastasis and death, and immediate therapy is mandatory. However, for these, the therapeutic options are highly invasive, such as radical prostatectomy, radiation or brachytherapy. Hence, a precise diagnosis of these tumor subtypes is needed, and the thus far applied diagnostic means are insufficient for this. Besides this, for their endless cell divisions, prostate cancer cells need the enzyme telomerase to elongate their telomeres (chromatin endings). In this study, we developed a gene regulatory model based on large data from transcription profiles from prostate cancer and chromatin-immuno-precipitation studies. We identified the developmental regulator PITX1 regulating telomerase. Besides observing experimental evidence of PITX1′s functional role in telomerase regulation, we also found PITX1 serving as a prognostic marker, as concluded from an analysis of more than 15,000 prostate cancer samples. Abstract The current risk stratification in prostate cancer (PCa) is frequently insufficient to adequately predict disease development and outcome. One hallmark of cancer is telomere maintenance. For telomere maintenance, PCa cells exclusively employ telomerase, making it essential for this cancer entity. However, TERT, the catalytic protein component of the reverse transcriptase telomerase, itself does not suit as a prognostic marker for prostate cancer as it is rather low expressed. We investigated if, instead of TERT , transcription factors regulating TERT may suit as prognostic markers. To identify transcription factors regulating TERT , we developed and applied a new gene regulatory modeling strategy to a comprehensive transcriptome dataset of 445 primary PCa. Six transcription factors were predicted as TERT regulators, and most prominently, the developmental morphogenic factor PITX1. PITX1 expression positively correlated with telomere staining intensity in PCa tumor samples. Functional assays and chromatin immune-precipitation showed that PITX1 activates TERT expression in PCa cells. Clinically, we observed that PITX1 is an excellent prognostic marker, as concluded from an analysis of more than 15,000 PCa samples. PITX1 expression in tumor samples associated with (i) increased Ki67 expression indicating increased tumor growth, (ii) a worse prognosis, and (iii) correlated with telomere length

Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNγ/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNγ/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNγ and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNγ/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNγ/IL10 may become a suitable theranostic marker for an urging clinical need

Use of IFNγ/IL10 Ratio for Stratification of Hydrocortisone Therapy in Patients With Septic Shock

Large clinical trials testing hydrocortisone therapy in septic shock have produced conflicting results. Subgroups may benefit of hydrocortisone treatment depending on their individual immune response. We performed an exploratory analysis of the database from the international randomized controlled clinical trial Corticosteroid Therapy of Septic Shock (CORTICUS) employing machine learning to a panel of 137 variables collected from the Berlin subcohort comprising 83 patients including demographic and clinical measures, organ failure scores, leukocyte counts and levels of circulating cytokines. The identified theranostic marker was validated against data from a cohort of the Hellenic Sepsis Study Group (HSSG) (n = 246), patients enrolled in the clinical trial of Sodium Selenite and Procalcitonin Guided Antimicrobial Therapy in Severe Sepsis (SISPCT, n = 118), and another, smaller clinical trial (Crossover study, n = 20). In addition, in vitro blood culture experiments and in vivo experiments in mouse models were performed to assess biological plausibility. A low serum IFNg/IL10 ratio predicted increased survival in the hydrocortisone group whereas a high ratio predicted better survival in the placebo group. Using this marker for a decision rule, we applied it to three validation sets and observed the same trend. Experimental studies in vitro revealed that IFNg/IL10 was negatively associated with the load of (heat inactivated) pathogens in spiked human blood and in septic mouse models. Accordingly, an in silico analysis of published IFNg and IL10 values in bacteremic and non-bacteremic patients with the Systemic Inflammatory Response Syndrome supported this association between the ratio and pathogen burden. We propose IFNg/IL10 as a molecular marker supporting the decision to administer hydrocortisone to patients in septic shock. Prospective clinical studies are necessary and standard operating procedures need to be implemented, particularly to define a generic threshold. If confirmed, IFNg/IL10 may become a suitable theranostic marker for an urging clinical need