Shedding Light on the Off-Hours Coverage Gap in Radiology: Improving Turnaround Times and Critical Results Reporting

Objective: Devise a plan to optimize off-hours faculty and trainee staffing within the Department of Radiology Measure the magnitude of patient safety gains in terms of report turnaround times (TAT) and critical results communication times (CRC)https://jdc.jefferson.edu/patientsafetyposters/1044/thumbnail.jp

Increasing Ultrasound-Guided Thyroid Biopsy Yield

Objectives: Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield Short Term\u3ereduce unsuccessful biopsies by 50% Long-Term\u3eeliminate unsuccessful biopsieshttps://jdc.jefferson.edu/patientsafetyposters/1064/thumbnail.jp

Needs Assessment: Northeast Philly Opioid Epidemic

Introduction: Philadelphia has the 3rd highest rate of opioid-related overdoses in the nation. This crisis is worsening in Northeast Philadelphia and the Department of Public Health lacks necessary information to intervene in an informed manner. Objective: This study aims to better understand the crisis in this community and to provide key information to guide future harm reduction interventions in the Northeast Philadelphia region. Methods: Using a designed discussion guide, qualitative interviews were completed with key stakeholders and community members. Information regarding personal experiences and opinions about the epidemic was gathered and interviews were analyzed using narrative analysis. In addition, needle counts were completed in public spaces. These counts were used to measure the free needle burden in this community. The findings of this study will be reported to the Department of Public Health. Results: Community member and stakeholder interviews produced a spectrum of opinions surrounding this issue. Major themes include the need for better access to needle exchange services and the idea that the harm reduction needed in this community differs from what would be accepted by its community members. The needle counts reveal that there is not a serious burden in the community, suggesting little need for further needle disposal kiosks in the area. Conclusion: In conclusion, future interventions should be centered around increasing needle exchange services and improving access and visibility of treatment centers in this community. Furthermore, further action should be taken to address the stigma of substance abuse in this community

Preparing Underrepresented High School Students to Increase Diversity in the Research and Health Professions

This article introduces the work that was done through the Coordinating Center at Charles R. Drew University of Medicine and Science

Understanding Humanitarian Supply Chain Logistics with Systems Dynamics Modeling

Purpose – We explore the short-term humanitarian response to a natural disaster that prompts a rapid influx of relief supplies to the area affected by the disaster, aiming to understand the dynamics of systemic processes that apply to humanitarian supply chain logistics. Design/methodology/approach – We use system dynamics to simulate the disaster relief supply chain elements of humanitarian response. System dynamics is a well-established simulation method for analyzing complex social systems that include feedback. We used it because the timing and coordination of, and feedback loops among, events in humanitarian response incorporate a delay structure that can be modeled effectively using system dynamics. Findings – Of all the stocks in our model of the Humanitarian Stock Management System, the most important was the Cumulative Food distributed to disaster victims. In all of our simulation runs, victims eventually got all the food they needed, but at varying speeds (fast in the base run, slow in runs where repair of infrastructure was slow). However, the most problematic stock was the amount of Food in the Central Warehouse. In almost all the runs, that stock contained an excess of food (which is very common in such situations), resulting in waste and inefficiency. This problem was worst when the agency panicked at the outset and doubled its estimate of needed food, and when, as is often true, the agency received too many in-kind donations of food. The most interesting finding was that “managing” donations led to the best overall performance--low waste, good relief for victims. Practical implications – We offer a number of policy recommendations, including the need to avoid early bias, to repair infrastructure as quickly as possible, to develop better methods for keeping track of inventories and supplies on the way, and striking a balance between encouraging and dampening donations. Originality/value – This study focuses on understanding the short-term dynamics of the logistics of a humanitarian response, using a system dynamics approach. There have been only two other studies applying system dynamics to humanitarian assistance. One was operational and focused on long-term dynamics (often called “development,” as opposed to “response”) and the other was abstract and focused on those same longer-term dynamics. While these studies have produced meaningful insight, our study is unique in that we have applied an operational approach to a short, or “crisis response,” time horizon

Reading Room Assistance Pilot: Improving Radiologist Workflow

Aims for Improvement Our aim for improvement was to find ways to decrease distractions and phone calls in the body radiology reading room and to convert unpredictable and “immediate-response distractions” to “managed distractions” that can be addressed without aborting patient care/case interpretation immediately and unnecessarily. The goal was to decrease interruptions which would allow more time to be spent on reading cases, learning, and teaching. One metric that we identified was the number of phone calls to the reading room, which we intend to decrease by 50% within the first quarter. Another metric was the radiology attending and resident attitudes toward workflow and efficiency in the reading room. We intend to assess radiologist perception of the workflow environment and a decrease in distractions as measured by a survey administered before and after implementation. Additionally, we expect to improve efficiency and will compare productivity in terms of care delivered/cases reviewed

Heat exposure and resilience planning in Atlanta, Georgia

The City of Atlanta, Georgia, is a fast-growing urban area with substantial economic and racial inequalities, subject to the impacts of climate change and intensifying heat extremes. Here, we analyze the magnitude, distribution, and predictors of heat exposure across the City of Atlanta, within the boundaries of Fulton County. Additionally, we evaluate the extent to which identified heat exposure is addressed in Atlanta climate resilience governance. First, land surface temperature (LST) was mapped to identify the spatial patterns of heat exposure and potential socioeconomic and biophysical predictors of heat exposure were assessed. Second, government and city planning documents and policies were analyzed to assess whether the identified heat exposure risks are addressed in Atlanta climate resilience planning. The average LST of Atlanta’s 305 block groups ranges from 23.7 °C (low heat exposure) in vegetated areas to 31.5 °C (high heat exposure) in developed areas across 13 summer days used to evaluate the spatial patterns of heat exposure (June-August, 2013-2019). In contrast to nationwide patterns, census block groups with larger historically marginalized populations (predominantly Black, less education, lower income) outside of Atlanta’s urban core display weaker relationships with LST (slopes ≈ 0) and are among the cooler regions of the city. Climate governance analysis revealed that although there are few strategies for heat resilience in Atlanta (n=12), the majority are focused on the city’s warmest region, the urban core, characterized by the city’s largest extent of impervious surface. These strategies prioritize protecting and expanding the city’s urban tree canopy, which has kept most of Atlanta’s marginalized communities under lower levels of outdoor heat exposure. Such a tree canopy can serve as an example of heat resilience for many cities across the United States and the globe

Lyrical Music Improves 5 km Time Trial Performance Compared to Non-Lyrical Music

This study examined the effects of lyrical music compared to non-lyrical music on 5 km running performance. Thirteen subjects with an average age of 33.5 ± 8.3 years of age ran three separate 5 km time trials. The first trial acted as a familiarization trial where no music was present, followed by either a lyrical or non-lyrical music trial in a random counterbalanced order. Trial times, RPE, HR, and questionnaire information was analyzed using paired samples t-tests, ANOVA, and multivariate regression analyses. Lyrical music showed a significant improvement over non-lyrical music improving performance time compared to non-lyrical music, on average by 36 ± 41s (p=.000). While not statistically significant, a trend showing lyrical music was faster than no music, followed by the slowest trial of non-lyrical music. No change was detected in HR, or RPE at the 3.05 km mark suggesting that at the end although subjects were working harder (indicated by the faster completion times) they do not perceive themselves to be working harder. A correlation between increased mileage and the decreased effects of music as an ergogenic aid was seen (p=.044 r=.638) which supports previous research. This study suggests that lyrical music may improve 5 km running performance compared to no lyrical music

Is TIMP-1 immunoreactivity alone or in combination with other markers a predictor of benefit from anthracyclines in the BR9601 adjuvant breast cancer chemotherapy trial?

INTRODUCTION: Predictive cancer biomarkers to guide the right treatment to the right patient at the right time are strongly needed. The purpose of the present study was to validate prior results that tissue inhibitor of metalloproteinase 1 (TIMP-1) alone or in combination with either HER2 or TOP2A copy number can be used to predict benefit from epirubicin (E) containing chemotherapy compared with cyclophosphamide, methotrexate and fluorouracil (CMF) treatment. METHODS: For the purpose of this study, formalin fixed paraffin embedded tumor tissue from women recruited into the BR9601 clinical trial, which randomized patients to E-CMF versus CMF, were analyzed for TIMP-1 immunoreactivity. Using previously collected data for HER2 amplification and TOP2A gene aberrations, we defined patients as "anthracycline non-responsive", that is, 2T (TIMP-1 immunoreactive and TOP2A normal) and HT (TIMP-1 immunoreactive and HER2 negative) and anthracycline responsive (all other cases). RESULTS: In total, 288 tumors were available for TIMP-1 analysis with (183/274) 66.8%, and (181/274) 66.0% being classed as 2T and HT responsive, respectively. TIMP-1 was neither associated with patient prognosis (relapse free survival or overall survival) nor with a differential effect of E-CMF and CMF. Also, TIMP-1 did not add to the predictive value of HER2, TOP2A gene aberrations, or to Ki67 immunoreactivity. CONCLUSION: This study could not confirm the predictive value of TIMP-1 immunoreactivity in patients randomized to receive E-CMF versus CMF as adjuvant treatment for primary breast cancer

A Rare Case of a Systemic Non-Langerhans Histiocytosis Presenting with Diabetes Insipidus and a Tentorial Mass

Introduction The histiocytoses are a group of clinically diverse diseases distinguished from one another based on the specific immunophenotype of the lesional cells, implying derivation from the same precursor cell. Langerhans cell histiocytoses (LCH) diseases stem from abnormal dendritic cell lineages, while the non-Langerhans cell histiocytoses (non-LCH) are usually derived from an abnormal monocyte/macrophage cell line.1 Non-LCH with central nervous system (CNS) involvement is predictive of poor outcome. Histopathology is used to make a diagnosis of non-LCH. Immunohistochemistry and the clinical setting are used to differentiate between the various subtypes of non-LCH.1 The non-LCH can be divided into cutaneous non-LCH, cutaneous with a major systemic component, and systemic non-LCH.1 Erdheim-Chester disease (ECD) and Rosai-Dorfman disease (RDD) are systemic non-LCH diseases. First described in 1930, ECD is characterized by xanthogranulomatous accumulations. The extent of infiltration is heterogeneous and can include skin, bones, lungs, kidneys, and the CNS. Approximately 500 cases have been reported so far.2 The majority of ECD patients harbor an activating mutation of the proto-oncogene BRAF, namely BRAF-V600E.3 Recent studies indicate CNS involvement as a predictor of highest mortality among ECD patients.4 First described in 1969, RDD is characterized by accumulation of histiocytes exhibiting emperipolesis in lymph nodes, in the head and neck or in extranodal sites. Extranodal sites include the CNS, skin, soft tissue and gastrointestinal tract. The clinical presentation is typically painless cervical lymphadenopathy with leukocytosis and a fever.5 The etiology of RDD is unknown.6 RDD with CNS involvement is rare and approximately 210 cases have been reported. CNS involvement typically lacks extracranial lymphadenopathy and resembles meningioma radiologically and clinically. 1 Select cases have demonstrated a combined presentation of ECD and RDD.2 In this report we describe a rare case presenting with headache and with clinically and pathologically overlapping features of RDD and ECD. We describe treatment and complications and review the existing literature regarding diagnosis and treatment for these rare conditions