Implementing PODS (Patient Oriented Discharge Summary) in an acute medical urban health setting in Vancouver, Canada

The transition from hospital to home or community is a vulnerable time for patients and families, who face risks associated with misunderstanding instructions about medications, self-monitoring and when to seek emergency care. The quality of the discharge process can have a significant impact on patient confidence, overall patient experience, ability to manage health at home, and hospital readmission rates. Patient Oriented Discharge Summary (PODS) is a standardized form and set of process changes, utilized to overcome communication barriers faced at discharge. We implemented PODS in two Acute Medicine units of a tertiary care hospital in western Canada and used a mixed-methods approach to evaluate the four process changes (PODS form, use of teach-back, engagement of caregivers in discharge teaching, follow-up phone calls). Evaluation showed that 60% of patients received PODS and 87% found the form helpful. There was a large increase in the percentage of patients who felt adequately prepared at the time of discharge, and a 10% increase in the number of patients who rated their overall hospital experience positively. Healthcare providers reported that using PODS they were more confident that patients were adequately prepared to return home. The update of PODS on the implementation units has been sustained at 60% for 18 months. Implementation of the PODS form and process can be accomplished with an interdisciplinary team, leadership support and by working closely with Patient Family Partners. PODS can improve the discharge process even in the complex urban acute medical environment in ways that offer wide-reaching benefits. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Drug Use in Street Sex worKers (DUSSK) study – results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers

OBJECTIVES: The majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study. SETTING: Female SSW charity premises in a large UK inner city. PARTICIPANTS: Females aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month. INTERVENTION: Female SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service. RESULTS: (1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant's lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating. CONCLUSIONS: Recruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial

Multi-epoch VLBI of a double maser super burst

In a rare and spectacular display, two well-known massive star forming regions, W49N and G25.65+1.05, recently underwent maser 'super burst' - their fluxes suddenly increasing above 30,000 and 18,000 Jy, respectively, reaching several orders of magnitude above their usual values. In quick-response, ToO observations with the EVN, VLBA and KaVA were obtained constituting a 4 week campaign - producing a high-cadence multi-epoch VLBI investigation of the maser emission. The combination of high-resolution, polarisation and flux monitoring during the burst provides one of the best accounts, to date, of the maser super burst phenomenon, aiding their use as astrophysical tools. These proceedings contain the preliminary results of our campaign

‘We are labeled as gang members, even though we are not’: belonging, aspirations and social mobility in Cartagena

This paper explores how belonging and aspirations interact to shape marginalized young Colombians’ strategies for upward social mobility. Recent literature has argued that in the context of inequality and poverty, social mobility is constrained by people’s inability to aspire to and/or achieve their aspirations. The majority of this literature is from the economics field and looks at the way poverty acts as a brake on social mobility. This paper provides an additional interdisciplinary analysis of the role of ‘belonging’ (to places and social class) in influencing aspirations of young Colombians. Findings are based on ethnographic fieldwork with young people from two marginalized neighborhoods in Cartagena. It is argued that aspirations are closely linked to belonging and the extent to which young people feel integral to or distanced from their localities. Using a Bourdieusian perspective, the paper examines how belonging is developed and how it influences behavior, orientations and future prospects. This approach generates insights into young people’s apparent low aspirations beyond the explanation of internal behavioral poverty traps. In so doing, it provides a more comprehensive understanding of how societal structures limit aspiration development and achievement

The moving minimum audible angle is smaller during self motion than during source motion

We are rarely perfectly still: our heads rotate in three axes and move in three dimensions, constantly varying the spectral and binaural cues at the ear drums. In spite of this motion, static sound sources in the world are typically perceived as stable objects. This argues that the auditory system-in a manner not unlike the vestibulo-ocular reflex-works to compensate for self motion and stabilize our sensory representation of the world. We tested a prediction arising from this postulate: that self motion should be processed more accurately than source motion. We used an infrared motion tracking system to measure head angle, and real-time interpolation of head related impulse responses to create "head-stabilized" signals that appeared to remain fixed in space as the head turned. After being presented with pairs of simultaneous signals consisting of a man and a woman speaking a snippet of speech, normal and hearing impaired listeners were asked to report whether the female voice was to the left or the right of the male voice. In this way we measured the moving minimum audible angle (MMAA). This measurement was made while listeners were asked to turn their heads back and forth between ± 15° and the signals were stabilized in space. After this "self-motion" condition we measured MMAA in a second "source-motion" condition when listeners remained still and the virtual locations of the signals were moved using the trajectories from the first condition. For both normal and hearing impaired listeners, we found that the MMAA for signals moving relative to the head was ~1-2° smaller when the movement was the result of self motion than when it was the result of source motion, even though the motion with respect to the head was identical. These results as well as the results of past experiments suggest that spatial processing involves an ongoing and highly accurate comparison of spatial acoustic cues with self-motion cues

Trans-cerebral HCO3- and PCO2 exchange during acute respiratory acidosis and exercise-induced metabolic acidosis in humans

This study investigated trans-cerebral internal jugular venous-arterial bicarbonate ([HCO(3)(−)]) and carbon dioxide tension (PCO(2)) exchange utilizing two separate interventions to induce acidosis: 1) acute respiratory acidosis via elevations in arterial PCO(2) (PaCO(2)) (n = 39); and 2) metabolic acidosis via incremental cycling exercise to exhaustion (n = 24). During respiratory acidosis, arterial [HCO(3)(−)] increased by 0.15 ± 0.05 mmol ⋅ l(−1) per mmHg elevation in PaCO(2) across a wide physiological range (35 to 60 mmHg PaCO(2); P < 0.001). The narrowing of the venous-arterial [HCO(3)(−)] and PCO(2) differences with respiratory acidosis were both related to the hypercapnia-induced elevations in cerebral blood flow (CBF) (both P < 0.001; subset n = 27); thus, trans-cerebral [HCO(3)(−)] exchange (CBF × venous-arterial [HCO(3)(−)] difference) was reduced indicating a shift from net release toward net uptake of [HCO(3)(−)] (P = 0.004). Arterial [HCO(3)(−)] was reduced by −0.48 ± 0.15 mmol ⋅ l(−1) per nmol ⋅ l(−1) increase in arterial [H(+)] with exercise-induced acidosis (P < 0.001). There was no relationship between the venous-arterial [HCO(3)(−)] difference and arterial [H(+)] with exercise-induced acidosis or CBF; therefore, trans-cerebral [HCO(3)(−)] exchange was unaltered throughout exercise when indexed against arterial [H(+)] or pH (P = 0.933 and P = 0.896, respectively). These results indicate that increases and decreases in systemic [HCO(3)(−)] – during acute respiratory/exercise-induced metabolic acidosis, respectively – differentially affect cerebrovascular acid-base balance (via trans-cerebral [HCO(3)(−)] exchange)

Impact of animal breeding on GHG emissions and farm economics

This report reviews the existing evidence regarding the current and potential use of animal breeding to reduce GHG emissions. It also comments on the likely impact of breeding on farm economics, identifies barriers to achieving GHG reductions via breeding and highlights some future research needs. The report focuses on the following livestock commodities within the EU-28: cattle meat, cattle milk, pigmeat, chicken meat and hen’s eggs. Together these account for approximately 95% of the emissions from European livestock (measured from cradle to farm gate, i.e. including on-farm emissions plus emissions arising pre-farm from the production of inputs such as feed, fertiliser and fuel).JRC.D.4-Economics of Agricultur

Hemoglobin and cerebral hypoxic vasodilation in humans: evidence for nitric oxide-dependent and S-nitrosothiol mediated signal transduction

Cerebral hypoxic vasodilation is poorly understood in humans, which undermines the development of therapeutics to optimize cerebral oxygen delivery. Across four investigations (total n = 195) we investigated the role of nitric oxide (NO) and hemoglobin-based S-nitrosothiol (RSNO) and nitrite ((Formula presented.)) signaling in the regulation of cerebral hypoxic vasodilation. We conducted hemodilution (n = 10) and NO synthase inhibition experiments (n = 11) as well as hemoglobin oxygen desaturation protocols, wherein we measured cerebral blood flow (CBF), intra-arterial blood pressure, and in subsets of participants trans-cerebral release/uptake of RSNO and (Formula presented.). Higher CBF during hypoxia was associated with greater trans-cerebral RSNO release but not (Formula presented.), while NO synthase inhibition reduced cerebral hypoxic vasodilation. Hemodilution increased the magnitude of cerebral hypoxic vasodilation following acute hemodilution, while in 134 participants tested under normal conditions, hypoxic cerebral vasodilation was inversely correlated to arterial hemoglobin concentration. These studies were replicated in a sample of polycythemic high-altitude native Andeans suffering from excessive erythrocytosis (n = 40), where cerebral hypoxic vasodilation was inversely correlated to hemoglobin concentration, and improved with hemodilution (n = 6). Collectively, our data indicate that cerebral hypoxic vasodilation is partially NO-dependent, associated with trans-cerebral RSNO release, and place hemoglobin-based NO signaling as a central mechanism of cerebral hypoxic vasodilation in humans.</p

Hemoglobin and cerebral hypoxic vasodilation in humans:Evidence for nitric oxide-dependent and S-nitrosothiol mediated signal transduction

Cerebral hypoxic vasodilation is poorly understood in humans, which undermines the development of therapeutics to optimize cerebral oxygen delivery. Across four investigations (total n = 195) we investigated the role of nitric oxide (NO) and hemoglobin-based S-nitrosothiol (RSNO) and nitrite ((Formula presented.)) signaling in the regulation of cerebral hypoxic vasodilation. We conducted hemodilution (n = 10) and NO synthase inhibition experiments (n = 11) as well as hemoglobin oxygen desaturation protocols, wherein we measured cerebral blood flow (CBF), intra-arterial blood pressure, and in subsets of participants trans-cerebral release/uptake of RSNO and (Formula presented.). Higher CBF during hypoxia was associated with greater trans-cerebral RSNO release but not (Formula presented.), while NO synthase inhibition reduced cerebral hypoxic vasodilation. Hemodilution increased the magnitude of cerebral hypoxic vasodilation following acute hemodilution, while in 134 participants tested under normal conditions, hypoxic cerebral vasodilation was inversely correlated to arterial hemoglobin concentration. These studies were replicated in a sample of polycythemic high-altitude native Andeans suffering from excessive erythrocytosis (n = 40), where cerebral hypoxic vasodilation was inversely correlated to hemoglobin concentration, and improved with hemodilution (n = 6). Collectively, our data indicate that cerebral hypoxic vasodilation is partially NO-dependent, associated with trans-cerebral RSNO release, and place hemoglobin-based NO signaling as a central mechanism of cerebral hypoxic vasodilation in humans.</p