Reducing ED Overcrowding by Improving Inpatient Flow

Crowding in the Emergency Department can lead to long wait times to see a provider, arrive at a diagnosis, and transition to inpatient care or discharge. Better flow in the ED can improve both inpatient length of stay and patient satisfaction. LEAN tools and operational excellence design are two effective methods to reduce ED overcrowding and decrease wait times. Listen to learn how a LEAN approach reduced wait times and improved throughput in an academic emergency department. Presentation: 52:0

Violence Has No Home in Healthcare

Throughout the COVID-19 pandemic, increased stress and anxiety has only further exacerbated the problem of violence in hospitals and other healthcare settings. Through the Safer Hospitals Initiative, Connecticut hospitals have united to develop and implement strategies to create a culture of safety for patients and staff within each of the institutions. This initiative applies the power of high reliability principles to standardize approaches to combatting violence in microsystems and macrosystems throughout an organization. We will share the strategies that may be replicated in your organizations to keep individuals working in healthcare organizations safer by stopping violence before it begins

Learners Self-directing Learning in FutureLearn MOOCs: A Learner-Centered Study

This qualitative research study focuses on how experienced online learners self-direct their learning while engaging in a MOOC delivered on the FutureLearn platform. Self-directed learning is an important concept within informal learning and online learning. This study distinguishes itself from previous MOOC learner studies, by reporting the self-directed learning using a bottom-up approach. By looking at self-reported learning logs and interview transcripts an in-depth analysis of the self-directed learning is achieved. The data analysis used constructed grounded theory, which aligns with the bottom-up approach where the learner data is coded and investigated in an open, yet evidence-based way, leaving room for insights to emerge from the learner data. The data corpus is based on 56 participants following three FutureLearn MOOCs, providing 147 learning logs and 19 semi-structured one-on-one interviews with a selection of participants. The results show five specific areas in which learners react with either the material or other learners to self-direct their learning: context, individual or social learning, technology and media provided in the MOOCs, learner characteristics and organising learning. This study also indicates how intrinsic motivation and personal learning goals are the main inhibitors or enablers of self-directed learning

Presymptomatic risk assessment for chronic non-communicable diseases

The prevalence of common chronic non-communicable diseases (CNCDs) far overshadows the prevalence of both monogenic and infectious diseases combined. All CNCDs, also called complex genetic diseases, have a heritable genetic component that can be used for pre-symptomatic risk assessment. Common single nucleotide polymorphisms (SNPs) that tag risk haplotypes across the genome currently account for a non-trivial portion of the germ-line genetic risk and we will likely continue to identify the remaining missing heritability in the form of rare variants, copy number variants and epigenetic modifications. Here, we describe a novel measure for calculating the lifetime risk of a disease, called the genetic composite index (GCI), and demonstrate its predictive value as a clinical classifier. The GCI only considers summary statistics of the effects of genetic variation and hence does not require the results of large-scale studies simultaneously assessing multiple risk factors. Combining GCI scores with environmental risk information provides an additional tool for clinical decision-making. The GCI can be populated with heritable risk information of any type, and thus represents a framework for CNCD pre-symptomatic risk assessment that can be populated as additional risk information is identified through next-generation technologies.Comment: Plos ONE paper. Previous version was withdrawn to be updated by the journal's pdf versio

Coupling of alpha(1)-Adrenoceptors to ERK1/2 in the Human Prostate

Introduction: alpha(1)-Adrenoceptors are considered critical for the regulation of prostatic smooth muscle tone. However, previous studies suggested further alpha(1)-adrenoceptor functions besides contraction. Here, we investigated whether alpha(1)-adrenoceptors in the human prostate may activate extracellular signal-regulated kinases (ERK1/2). Methods: Prostate tissues from patients undergoing radical prostatectomy were stimulated in vitro. Activation of ERK1/2 was assessed by Western blot analysis. Expression of ERK1/2 was studied by immunohistochemistry. The effect of ERK1/2 inhibition by U0126 on phenylephrine-induced contraction was studied in organ-bath experiments. Results: Stimulation of human prostate tissue with noradrenaline (30 mu M) or phenylephrine (10 mu M) resulted in ERK activation. This was reflected by increased levels of phosphorylated ERK1/2. Expression of ERK1/2 in the prostate was observed in smooth muscle cells. Incubation of prostate tissue with U0126 (30 mu M) resulted in ERK1/2 inhibition. Dose-dependent phenylephrine-induced contraction of prostate tissue was not modulated by U0126. Conclusions: alpha(1)-Adrenoceptors in the human prostate are coupled to ERK1/2. This may partially explain previous observations suggesting a role of alpha(1)-adrenoceptors in the regulation of prostate growth. Copyright (C) 2011 S. Karger AG, Base

Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery

Anastomotic leakage is a serious complication after colorectal surgery. Pre- and intraoperative factors may contribute to failure of colorectal anastomosis. In this study we have tried to determine risk factors for anastomotic leakage, with special emphasis on intraoperative blood pressure changes. During a 24-month period, patients receiving a colorectal anastomosis were prospectively evaluated. For each patient preoperative characteristics, intraoperative adverse events and surgical outcome data were collected. Blood pressure changes were calculated as a relative decrease (> 25% and > 40%) from preoperative baseline values. During the study period, 285 patients underwent colorectal surgery with an anastomosis. Fifteen patients developed an anastomotic leakage (5.3%). All patients who developed a leakage had a left-sided procedure (P 40% decrease in diastolic blood pressure (P = 0.049)] were identified as univariate risk factors for anastomotic leakage. The development of an anastomotic leakage after colorectal surgery is related to surgical, patient and anaesthetic risk factors. A high preoperative diastolic blood pressure and profound intraoperative hypotension combined with complex surgery, marked by a blood loss of a parts per thousand yen250 mL and the occurrence of intraoperative adverse events, is associated with an increased risk of developing anastomotic leakag

Femtosecond Dynamics in Single Wall Carbon Nanotube/Poly(3-Hexylthiophene) Composites

Femtosecond transient absorption measurements on single wall carbon nanotube/poly(3-hexylthiophene) composites are used to investigate the relaxation dynamics of this blended material. The influence of the addition of nanotubes in polymer matrix on the ultrashort relaxation dynamics is examined in detail. The introduction of nanotube/polymer heterojunctions enhances the exciton dissociation and quenches the radiative recombination of composites. The relaxation dynamics of these composites are compared with the fullerene derivative-polymer composites with the same matrix. These results provide explanation to the observed photovoltaic performance of two types of composites