Anesthesia-to-Post Anesthesia Care Unit Handoff Standardization

Abstract The exchange of medical information from one medical professional to another is known as the handoff. Communication errors during the transition period of handoffs can lead to medication errors, delays in care, high stress within the work environment, and increased burnout of the nursing staff. Approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to healthcare communication failures from 2012 to 2017. One of the areas of the hospital where effective handoffs are critically important, given the high frequency, is in the post-anesthesia care unit (PACU). Major organizations such as the Joint Commission, the World Health Organization, and the American Association of Nurse Anesthetists have created goals to standardize PACU handoffs in efforts to address the problem. PACU handoff standardization has also been voiced as a priority for the project organization. The purpose of this evidence-based quality improvement project is to implement a standardized handoff tool at the project organization site. After searching for and critically appraising the literature, the project team will implement the Written Anesthesia Handoff Tool (WHAT). This project’s development, implementation, and evaluation will be guided by a framework called the Evidence-Based Practice Improvement Model. The aim of the project is increasing nurse satisfaction with the utilization of a handoff tool. The goals of the project are to implement a checklist as a handoff tool to evaluate nurse satisfaction before and after the handoff tool is implemented. Keywords: handoff, post-anesthesia care unit, PACU, PACU handoffs, standardization, PACU handoff standardization, standardized handoff, Evidence-Based Practice Improvement Model, Written Anesthesia Handoff Tool, WHAT Tool, handoff tool, handoff checklist, nurse satisfactio

Effect of time at temperature on wild poliovirus titers in stool specimens

AbstractBackgroundThe effect of transport temperature on the viability of poliovirus in stool specimens from paralyzed cases has not been tested. Quality assurance of programmatic indicators will be necessary in the final phase of polio eradication.ObjectiveTo estimate the effect of time at elevated temperatures on wild poliovirus titers in stool specimens.MethodsWe exposed aliquots of pooled wild poliovirus type 1 specimens to elevated temperatures (27°C, 31°C, and 35°C) for varying time periods up to 14 days. We determined the virus titer of these aliquots and created decay curves at each temperature to estimate the relationship between time at temperature and virus titer.ResultsWe found significantly different slopes of decay at each temperature. The negative slopes increased as the temperature increased.ConclusionsWhile poliovirus in stool remains relatively stable at moderately elevated temperature, transport at higher temperatures could impact sample integrity and virus isolation results

A lack of confirmation with alternative assays questions the validity of IL-17A expression in human neutrophils using immunohistochemistry

We identified IL-17A-positive neutrophils in Wolbachia-positive Onchocerca volvulus nodules using an antibody that has previously reported IL-17A-positive neutrophils in several inflammatory conditions. However, we could not detect IL-17A using a range of alternative assays. Our data question the IL-17A antibody specificity and the ability of human neutrophils to express IL-17A

Human filarial Wolbachia lipopeptide directly activates human neutrophils in vitro.

The host inflammatory response to the Onchocerca volvulus endosymbiont, Wolbachia, is a major contributing factor in the development of chronic pathology in humans (onchocerciasis/river blindness). Recently, the toll-like pattern recognition receptor motif of the major inflammatory ligands of filarial Wolbachia, membrane-associated diacylated lipoproteins, were functionally defined in murine models of pathology, including mediation of neutrophil recruitment to the cornea. However, the extent to which human neutrophils can be activated in response to this Wolbachia pattern recognition motif is not known. Therefore, the responses of purified peripheral blood human neutrophils to a synthetic N-terminal diacylated lipopeptide (WoLP) of filarial Wolbachia peptidoglycan-associated lipoprotein (PAL) were characterised. WoLP exposure led to a dose-dependent activation of healthy, human neutrophils that included gross morphological alterations and modulation of surface expressed integrins involved in tethering, rolling and extravasation. WoLP exposure induced chemotaxis but not chemokinesis of neutrophils, and secretion of the major neutrophil chemokine, interleukin 8. WoLP also induced and primed the respiratory burst, and enhanced neutrophil survival by delay of apoptosis. These results indicate that the major inflammatory motif of filarial Wolbachia lipoproteins directly activates human neutrophils in vitro and promotes a molecular pathway by which human neutrophils are recruited to sites of Onchocerca parasitism

NASA's Launch Propulsion Systems Technology Roadmap

Safe, reliable, and affordable access to low-Earth (LEO) orbit is necessary for all of the United States (US) space endeavors. In 2010, NASA s Office of the Chief Technologist commissioned 14 teams to develop technology roadmaps that could be used to guide the Agency s and US technology investment decisions for the next few decades. The Launch Propulsion Systems Technology Area (LPSTA) team was tasked to address the propulsion technology challenges for access to LEO. The developed LPSTA roadmap addresses technologies that enhance existing solid or liquid propulsion technologies and their related ancillary systems or significantly advance the technology readiness level (TRL) of less mature systems like airbreathing, unconventional, and other launch technologies. In developing this roadmap, the LPSTA team consulted previous NASA, military, and industry studies as well as subject matter experts to develop their assessment of this field, which has fundamental technological and strategic impacts for US space capabilities

The critical detection distance for passively tracking tagged fish using a fixed radio telemetry station in a small stream

Background: Fixed radio telemetry stations are used to study the movement ecology of fishes in streams and rivers. A common assumption of such studies is that detection efficiency remains constant through space and time. The objective of this study was to understand how site characteristics and tag distance can influence the detection efficiency of a fixed receiver when used for fisheries research in a small stream. Field tests included a fixed receiver station on Forty Mile Creek, in Banff National Park, AB, Canada that recorded signals from radio tags over specified distances (i.e., 0 m, 27 m, 53 m, 80 m) within the expected detection range from July to October, 2016. Model selection was used to test which parameters may influence detection efficiency. Results: The fixed receiver was able to record an average of 89% of transmissions over the study period. Detection efficiency was greater or equal to 0.97 at tag di

Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice

<p>Abstract</p> <p>Background</p> <p>Extracranial traumatic cerebrovascular injury (TCVI) is present in 1-3% of all blunt force trauma patients. Although options for the management of patients with these lesions include anticoagulation, antiplatelet agents, and endovascular treatment, the optimal management strategy for patients with these lesions is not yet established.</p> <p>Objective</p> <p>Multidisciplinary survey of clinicians about current management of TCVI.</p> <p>Methods</p> <p>A six-item multiple-choice survey was sent by electronic mail to a total of 11,784 neurosurgeons, trauma surgeons, stroke neurologists, and interventional radiologists. The survey included questions about their choice of imaging, medical management, and the use of endovascular techniques. Survey responses were analyzed according to stated specialty.</p> <p>Results</p> <p>Seven hundred eighty-five (6.7%) responses were received. Overall, a total of 325 (42.8%) respondents favored anticoagulation (heparin and/or warfarin), 247 (32.5%) favored antiplatelet drugs, 130 (17.1%) preferred both anticoagulation and antiplatelet drugs, and 57 (7.5%) preferred stenting and/or embolization. Anticoagulation was the most commonly preferred treatment among vascular surgeons (56.9%), neurologists (50.2%) and neurosurgeons (40.7%), whereas antiplatelet agents were the most common preferred treatment among trauma surgeons (41.5%). Overall, 158 (20.7%) of respondents recommended treatment of asymptomatic dissections and traumatic aneurysms, 211 (27.7%) did not recommend it, and 39.4% recommended endovascular treatment only if there is worsening of the lesion on follow-up imaging.</p> <p>Conclusions</p> <p>These data demonstrate the wide variability of physicians' management of traumatic cerebrovascular injury, both on an individual basis, and between specialties. These findings underscore the need for multicenter, randomized trials in this field.</p

Eosinophil-Mediated Immune Control of Adult Filarial Nematode Infection Can Proceed in the Absence of IL-4 Receptor Signaling

Helminth infections are accompanied by eosinophilia in parasitized tissues. Eosinophils are effectors of immunity to tissue helminths. We previously reported that in the context of experimental filarial nematode infection, optimum tissue eosinophil recruitment was coordinated by local macrophage populations following IL-4R–dependent in situ proliferation and alternative activation. However, in the current study, we identify that control of chronic adult filarial worm infection is evident in IL-4Ra–deficient (IL-4Ra2/2) mice, whereby the majority of infections do not achieve patency. An associated residual eosinophilia was apparent in infected IL-4Ra2/2 mice. By treating IL-4Ra2/2 mice serially with anti-CCR3 Ab or introducing a compound deficiency in CCR3 within IL-4Ra2/2 mice, residual eosinophilia was ablated, and susceptibility to chronic adult Brugia malayi infection was established, promoting a functional role for CCR3-dependent eosinophil influx in immune control in the absence of IL-4/IL13–dependent immune mechanisms. We investigated additional cytokine signals involved in residual eosinophilia in the absence IL-4Ra signaling and defined that IL-4Ra2/2/IL-52/2 double-knockout mice displayed significant eosinophil deficiency compared with IL-4Ra2/2 mice and were susceptible to chronic fecund adult filarial infections. Contrastingly, there was no evidence that either IL-4R–dependent or IL-4R–independent/CCR3/IL-5–dependent immunity influenced B. malayi microfilarial loads in the blood. Our data demonstrate multiplicity of Th2-cytokine control of eosinophil tissue recruitment during chronic filarial infection and that IL-4R–independent/IL-5– and CCR3-dependent pathways are sufficient to control filarial adult infection via an eosinophil-dependent effector response prior to patency