Structuring communication relationships for interprofessional teamwork (SCRIPT): a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Despite a burgeoning interest in using interprofessional approaches to promote effective collaboration in health care, systematic reviews find scant evidence of benefit. This protocol describes the first cluster randomized controlled trial (RCT) to design and evaluate an intervention intended to improve interprofessional collaborative communication and patient-centred care.</p> <p>Objectives</p> <p>The objective is to evaluate the effects of a four-component, hospital-based staff communication protocol designed to promote collaborative communication between healthcare professionals and enhance patient-centred care.</p> <p>Methods</p> <p>The study is a multi-centre mixed-methods cluster randomized controlled trial involving twenty clinical teaching teams (CTTs) in general internal medicine (GIM) divisions of five Toronto tertiary-care hospitals. CTTs will be randomly assigned either to receive an intervention designed to improve interprofessional collaborative communication, or to continue usual communication practices.</p> <p>Non-participant naturalistic observation, shadowing, and semi-structured, qualitative interviews were conducted to explore existing patterns of interprofessional collaboration in the CTTs, and to support intervention development. Interviews and shadowing will continue during intervention delivery in order to document interactions between the intervention settings and adopters, and changes in interprofessional communication.</p> <p>The primary outcome is the rate of unplanned hospital readmission. Secondary outcomes are length of stay (LOS); adherence to evidence-based prescription drug therapy; patients' satisfaction with care; self-report surveys of CTT staff perceptions of interprofessional collaboration; and frequency of calls to paging devices. Outcomes will be compared on an intention-to-treat basis using adjustment methods appropriate for data from a cluster randomized design.</p> <p>Discussion</p> <p>Pre-intervention qualitative analysis revealed that a substantial amount of interprofessional interaction lacks key core elements of collaborative communication such as self-introduction, description of professional role, and solicitation of other professional perspectives. Incorporating these findings, a four-component intervention was designed with a goal of creating a culture of communication in which the fundamentals of collaboration become a routine part of interprofessional interactions during unstructured work periods on GIM wards.</p> <p>Trial registration</p> <p>Registered with National Institutes of Health as NCT00466297.</p

Itegrated Test and Evaluation of a 4-Bed Molecular Sieve (4BMS) Carbon Dioxide Removtal System (CDRA), Mechanical Compressor Engineering Development Unit (EDU), and Sabitier Engineering Development Unit (EDU)

Currently on the International Space Station s (ISS) U.S. Segment, carbon dioxide (CO2) scrubbed from the cabin by a 4-Bed Molecular Sieve (4BMS) Carbon Dioxide Removal Assembly (CDRA) is vented overboard as a waste product. Likewise, the product hydrogen (H2) that will be generated by the Oxygen Generation Assembly (OGA) planned for installation will also be vented. A flight experiment has been proposed that will take the waste CO2 removed from the cabin, and via the catalytic Sabatier process, reduce it with waste H2 to generate water and methane. The water produced may provide cost and logistics savings for ISS by reducing the amount of water periodically re-supplied to orbit. To make this concept viable, a mechanical piston compressor and accumulator were developed for collecting and storing the CO2 from the CDRA. The compressor, accumulator and Sabatier system would be packaged together as one unit and referred to as the Carbon Dioxide Reduction Assembly (CRA). Testing was required to evaluate the performance of a 4BMS CDRA, compressor, accumulator, and Sabatier performance along with their operating rules when integrated together. This had been numerically modeled and simulated; however, testing was necessary to verify the results from the engineering analyses. Testing also allowed a better understanding of the practical inefficiencies and control issues involved in a fully integrated system versus the theoretical ideals in the model. This paper presents and discusses the results of an integrated engineering development unit test

Disk Loss and Disk Renewal Phases in Classical Be Stars I: Analysis of Long-Term Spectropolarimetric Data

(Abridged) Classical Be stars occasionally transition from having a gaseous circumstellar disk (''Be phase'') to a state in which all observational evidence for the presence of these disks disappears (''normal B-star phase''). We present one of the most comprehensive spectropolarimetric views to date of such a transition for two Be stars, pi Aquarii and 60 Cygni. 60 Cyg's disk loss episode was characterized by a monotonic decrease in emission strength over a time-scale of 1000 days, consistent with the viscous time-scale of the disk, assuming alpha is 0.14. pi Aqr's disk loss was episodic in nature and occurred over a time-scale of 2440 days. An observed time lag between the behavior of the polarization and H-alpha in both stars indicates the disk clearing proceeded in an ''inside-out'' manner. We determine the position angle of the intrinsic polarization to be 166.7 +/- 0.1 degrees for pi Aqr and 107.7 +/- 0.4 degrees for 60 Cyg, and model the observed polarization during the quiescent diskless phase of each star to determine the interstellar polarization along the line of sight. Minor outbursts observed during the quiescent phase of each star shared similar lifetimes as those previously reported for mu Cen, suggesting that the outbursts represent the injection and subsequent viscous dissipation of individual blobs of material into the inner circumstellar environments of these stars. We also observe deviations from the mean intrinsic polarization position angle during polarization outbursts in each star, indicating deviations from axisymmetry. We propose that these deviations might be indicative of the injection (and subsequent circularization) of new blobs into the inner disk, either in the plane of the bulk of the disk material or in a slightly inclined (non-coplanar) orbit.Comment: 30 pages, 14 figures; accepted in Ap

The Lantern Vol. 34, No. 1, December 1967

• il se fait tard • il pleut • For GM • A Fragile Fragment • Epic in Stereo • Kisskraft • The Critical Marquis • Sea Flame • Belladonna • Haiku • Symphony • Ziegfortenblat • It\u27s One of Those Nights • Contentment • Short-sighted and Mildly Unbelievable • Society\u27s Children • Crowded Mirrors • Child in Bright Colors • The Long-range Accident • The Ultimate Machine • They Live in a Crowded Area • Beastiary • Nocturne • I am Like a Candle • Two A.M. and After • Question Times Ten • College Blues • Poem at Midnight • Love Chaos-Style • Once Knew a Homespun Nanny • He Who Argues • Dying by the Water • Is This Prose • The Subintellectual • Untitled Series • Sunset Skirmish • Lyrics of the Field • That Day When I See • Haiku • When the Shadows Stopped • Luz-Maria • Prayerhttps://digitalcommons.ursinus.edu/lantern/1092/thumbnail.jp

Reflections on the Cost of Low-Cost Whole Genome Sequencing: Framing the Health Policy Debate

The cost of whole genome sequencing is dropping rapidly. There has been a great deal of enthusiasm about the potential for this technological advance to transform clinical care. Given the interest and significant investment in genomics, this seems an ideal time to consider what the evidence tells us about potential benefits and harms, particularly in the context of health care policy. The scale and pace of adoption of this powerful new technology should be driven by clinical need, clinical evidence, and a commitment to put patients at the centre of health care policy

The Lantern Vol. 49, No. 1, Fall 1982

• The Dormant Tree • Les Maitres des mots... • The Bartender • Time • Small Silent Creatures • Appreciation de la vie • Mon Seigneur, Mon Ami • In Gratitude • Cathedral • Child • Grow Old With Me • To Keep The Land • Lesetta • No Answer • The Hunt • You Came to Me • A Day in the Life of a Thought • Revenge • The Dance • Unclaimed • Where e\u27er There Be a Reason • Pour le coin • Thinking of You • You Were The Onehttps://digitalcommons.ursinus.edu/lantern/1121/thumbnail.jp

Wealth Building in Rural America: Programs, Policies, Research

Wealth Building in Rural America: Programs, Policies, Researc

Long-Term Administration of Conjugated Estrogen and Bazedoxifene Decreased Murine Fecal β-Glucuronidase Activity Without Impacting Overall Microbiome Community

AbstractConjugated estrogens (CE) and Bazedoxifene (BZA) combination is used to alleviate menopause-associated symptoms in women. CE+BZA undergo first-pass-metabolism in the liver and deconjugation by gut microbiome via β-glucuronidase (GUS) enzyme inside the distal gut. To date, the impact of long-term exposure to CE+BZA on the gut microbiome or GUS activity has not been examined. Our study using an ovariectomized mouse model showed that CE+BZA administration did not affect the overall cecal or fecal microbiome community except that it decreased the abundance of Akkermansia, which was identified as a fecal biomarker correlated with weight gain. The fecal GUS activity was reduced significantly and was positively correlated with the abundance of Lactobacillaceae in the fecal microbiome. We further confirmed in Escherichia coli K12 and Lactobacillus gasseri ADH that Tamoxifen-, 4-hydroxy-Tamoxifen- and Estradiol-Glucuronides competed for GUS activity. Our study for the first time demonstrated that long-term estrogen supplementation directly modulated gut microbial GUS activity. Our findings implicate that long-term estrogen supplementation impacts composition of gut microbiota and microbial activity, which affects estrogen metabolism in the gut. Thus, it is possible to manipulate such activity to improve the efficacy and safety of long-term administered estrogens for postmenopausal women or breast cancer patients.</jats:p