Decreasing unnecessary laboratory testing in medical critical care

The overuse of laboratory testing is common in the intensive care unit (ICU) which leads to an increased cost of care and an increased potential for harm to the patient. There is no evidence that obtaining daily laboratory tests helps to reduce mortality or morbidity in critical care patients. We conduced a retrospective study where chart review was performed to assess the frequency of unnecessary laboratory testing followed by a quality improvement initiative. With our study we were successful at reducing the inappropriate laboratory testing and improving the appropriate laboratory testing through our study

ECHINOCOCCUS GRANULOSUS GENOTYPE G8 IN MAINE MOOSE (ALCES ALCES)

During a 2012 survey of harvested moose (Alces alces) in Maine (USA), an incidental finding of hydatid cysts was found in 39% (21 of 54) of lung sets examined. Cytology of cyst contents was consistent with Echinococcus granulosus. The G8 genotype was identified based on PCR and DNA sequencing of a 470 base pair region of the NADH dehydrogenase subunit 1 (NAD1) mitochondrial gene. The hydatid cysts were the northern, or cervid genotype and this is the first confirmed report of E. granulosus in Maine moose. The Atlantic regions of the northern USA and Canada were not previously thought to be endemic regions for E. granulosus. It is presumed that either domestic dogs or eastern coyotes (Canis latrans) are the definitive host

In Vitro Susceptibility of Prototheca to Plant Hormones

Prototheca, an alga, can cause mastitis in cattle, does not respond to routine therapy and necessitates culling of productive animals. The resazurin microbroth dilution assay was adapted for use in a prototheca susceptibility trial. Using this assay, the susceptibility of prototheca against an antibiotic (Amphotericin B {AB}) and 2 plant hormones, Indolyl propionic acid (IPA) and Indolyl butyric acid (IBA), all prepared in deionized water, was tested. P. zopfii GT2 solutions were calibrated and found to grow better in RPMI-1640 broth versus prototheca isolation medium (PIM) at 48 hours. RPMI-1640 broth was found to be compatible with the full spectrum of resazurin color changes, as compared to PIM broth. Dye reduction (pink color change) was seen by 22 hours of incubation at the highest concentration of prototheca used. The amount of dye (2 or 4 μg using visual scoring) and concentration of prototheca (250 CFU per well) were optimized to allow results to be obtained at 48 to 72 hours. A visual scoring system was validated using prototheca culture, based on the different reduction stages of the dye. Spectrophotometric wavelengths of 575 and 610 were contrasted for use with this assay. Using the optimized assay, several concentrations of AB, IPA and IBA were tested. Resazurin was found to increase protothecal growth or counts on hemocytometer; this finding was unexplained. The dye may promote growth or increase prototheca solubility in the wells. AB was inhibitory to prototheca at 0.25-1 μg per ml; the color change (blue) was stable for 72 hours. IPA and IBA were non-inhibitory at the concentration utilized (242 pg per ml; a range of 6, 12 and 24 pg per well was tested). Alternative solvents may be needed to achieve effective (higher) concentrations

Impact of Flow Diversion and Temperature on Chinook Salmon Habitat in Lemhi River, ID, USA

Diversion of water from the stream changes the river physical processes and ecological integrity. Diversion from the stream mainly for irrigation from the Lemhi River, historically good habitat for Chinook salmon were affected. The study focused on quantifying impacts of water diversion on the juvenile and spawning life stages of Chinook salmon. The average flows of normal (October) and diverted (August) flow were considered for the study. Firstly, spatially distributed 2D hydrodynamic model was developed to simulate water depth, velocity, and temperature using MIKE21software. The heat exchange module was used for water temperature modeling. These simulated physical parameters (water depth, velocity, and temperature) and habitat preference curves were used to develop a habitat model to simulate habitat quality. The study results showed water temperature varies longitudinally and laterally in a stream. Furthermore, Chinook salmon habitat was altered due to flow diversion and change in water temperature, which is a result of a change in seasonal atmospheric temperature. The normal flow during October with low water temperature was found favorable for spawning life stage compared to the diverted flow during in August with high water temperature. Nevertheless, Juvenile habitat was not distinctly altered in our study as a result of the change in flow and water temperature. One of the novelties of this study is the application of 2D temperature model to simulate spatially distributed water temperature as a function of metrological drivers, which is an important parameter for salmonid habitat. The study provides insight to water managers to manage and restore salmonid habitat, which is sensitive to water temperature and streamflow changes

Investigation of Aerothermodynamic and Chemical Kinetic Models for High-Speed Nonequilibrium Flows

High speed flow problems of practical interest require a solution of nonequilibrium aerothermochemistry to accurately predict important flow phenomena including surface heat transfer and stresses. As a majority of these flow problems are in the continuum regime, Computational Fluid Dynamics (CFD) is a useful tool for flow modeling. This work presents the development of a nonequilibrium add-on solver to ANSYS Fluentutilizing user-definedfunctions to model salient aspects of nonequilibrium flow in air. The developed solver was verified for several benchmark nonequilibrium flow problems and compared with the available experimental data and other nonequilibrium flow simulations. The rate of dissociation behind a strong shock in thermochemical nonequilibrium depends on the vibrational excitation of molecules. The Macheret-Fridman (MF) classical impulsive model provides analytical expressions for nonequilibrium dissociation rates. The original form of the model was limited to the dissociation of homonuclear molecules. In this work, a general form of the MF model has been derived and present macroscopic rates applicable for modeling dissociation in CFD. Additionally, some improvements to the prediction of mean energy removed in dissociation in the MF-CFD model has been proposed based on the comparisons with available QCT data. In general, the results from the MF-CFD model upon investigating numerous nonequilibrium flows are promising and the model shows a possibility of becoming the standard tool for investigating nonequilibrium flows in CFD. The aerodynamic deorbit experiment (ADE) CubeSat has dragsail to accompany accelerated deorbiting of a CubeSat post-mission. A good estimation of the aerothermal load on a reentry CubeSat is paramount to ensure a predictable reentry. This study investigates the aerothermal load on an ADE CubeSat using the direct simulation Monte Carlo (DSMC) methods and Navier-Stokes-Fourier continuum based methods with slip boundary conditions. The aerothermal load on an ADE CubeSat at 90 km altitude from the DSMC and continuum methods were consistent with each other. The continuum breakdown at a higher altitude of 95 km resulted in a strong disagreement between the continuum and DSMC solutions. Overall, the continuum methods could offer a considerable computational cost saving to the DSMC methods in predicting aerothermal load on an ADE CubeSat at low altitudes

Improving Value (Low cost, Optimal Clinical Outcome, Patient Satisfaction) in a Skilled Nursing Facility: A Quality Improvement (QI) Project

Improving the value of care with reduced cost without compromising the quality is utmost important in the modern era of medical practice. An attempt was made in the nursing facility to observe an outcome with a plan to implement in much larger scale in the larger facility in future. In the 7-month period of this ambi- directional study, the focus was on minimizing unnecessary daily laboratory orders and to observe the reduction in the cost without adverse effect on length of stay in the nursing facility and hospitalization from the nursing facility

Analyses of Spatial and Temporal Variations of Salt Concentration in Waterbodies Based on High Resolution Measurements Using Sensors

Studies have shown that salt concentrations are increasing in waterbodies such as lakes, rivers, wetlands, and streams in areas where deicers are commonly applied for winter road maintenance, resulting in degraded water quality. As the salt concentration varies spatially and temporally based on environmental and hydrological characteristics, we monitored high resolution (15 min) salt concentrations for a relatively long period (winter and spring season) at different sites (i.e., stream, urban-stream, roadside drain, and parking-lot drain) using multiple electric conductivity-based sensors. The salt concentrations were significantly different from each other considering individual sensors and different sites in both winter and spring seasons, which support past research results that concentration varies spatially. Parking-lot (1136 ± 674 ppm) and Roadside (701 ± 263 ppm) drain measured significantly higher concentration than for Stream (260 ± 60 ppm) and Urban-stream (562 ± 266 ppm) in the winter season. Similar trends were observed for the spring season, however, the mean concentrations were lower in the spring. Furthermore, salt concentrations were significantly higher during the winter (242 ± 47 ppm to 1695 ± 629 ppm) than for the spring (140 ± 23 ppm to 863 ± 440 ppm) season considering different sites, which have been attributed to the winter snow maintenance practice using deicers in past studies. All sites exceed the United States Environmental Protection Agency (USEPA) threshold (salt concentration higher than 230 mg/L) for chronic exposure level for 59% to 94% and 10% to 83% of days in winter and spring seasons, respectively. The study has highlighted the usefulness and advantages of high resolution (spatially and temporally) salt concentration measurement using sensor technology. Furthermore, the salt concentration in waterbodies can vary spatially and temporally within a small spatial scale, which may be important information for managing water quality locally. The high resolution measurements (i.e., 15 min) were helpful to capture the highest potential salt concentrations in the waterbody. Therefore, the sensor technology can help to measure high resolution salt concentrations, which can be used to quantify impacts of high salt concentrations, e.g., application of deicer for winter road maintenance on aquatic systems based on the criteria developed by USEPA

Half-Dose Anticoagulation for Venous Thromboembolism and Phlegmasia Cerulea Dolens in a Patient With Recurrent Subdural Hematoma.

Anticoagulation for venous thromboembolism (VTE) in patients with recurrent subdural hematoma (SDH) is challenging. It becomes even more challenging when the patient develops phlegmasia cerulea dolens (PCD). We present a 66-year-old female with a recent history of recurrent SDH who received half-dose heparin therapy for VTE and PCD. The patient had improvement of dyspnea and resolution of PCD after two days of treatment. She was discharged with half-dose enoxaparin. At her one-month follow-up, there was no evidence of new SDH or progression of VTE. Half-dose anticoagulation therapy should be considered in patients with recurrent SDH when anticoagulation is inevitable