Dangers of Peripheral Intravenous Catheterization: The Forgotten Tourniquet and Other Patient Safety Considerations

Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. Due to its inherently invasive nature, intravenous (IV) therapy is associated with a number of potential complications, many of which are directly relevant to patient safety (PS). PIV-related morbidity may be due to mechanical or nonmechanical factors. The most frequent nonmechanical peripheral venous catheterization adverse events (PVCAEs) include insertion site pain, phlebitis, hematoma formation, and infusate extravasation. The most common mechanical PVCAE is catheter obstruction/occlusion and dislodgement. Significant complications can also occur with the administration of incorrect type or wrong amount of IV fluids. Moreover, simultaneous infusion of incompatible medications can result in infusate precipitation. Finally, less frequent but significant complications have been reported, including bloodstream and local infections, air embolization, nerve damage, arterial puncture, skin necrosis associated with vasopressor infusions, and limb-threatening forgotten tourniquet events. Taken together, the above complications can lead to substantial patient discomfort, unnecessary or prolonged hospitalization, increased costs, and additional downstream morbidity. Efforts to prevent PVCAEs and improve patient outcomes should involve thorough provider education, clinical vigilance by all involved healthcare providers, health service level strategies, as well as the proactive participation of all stakeholders, including patients and their families

The Importance of Post-Doctoral Program to GME in an Academic Medical Center

Continuous advancements in the medical field and the need to promote scientific evidence has increased the concern for educators to ensure that physician trainees are provided with the appropriate tools and experiences to develop the skills necessary to enhance scientific discovery. To address this requirement, the Accreditation Council for Graduate Medical Education (ACGME) implemented core competencies, inclusive of scholarly activity requirements, for accreditation of Graduate Medical Education (GME) programs. These changes have challenged institutions to educate differently and incorporate scholarly activity and research into their curriculum through novel and creative approaches. One such mechanism is the development of post-doctoral research programs which utilize research fellows to provide the necessary support for research productivity across multiple specialties. In the following chapter, the authors will provide some background information on the goals and function of the ACGME, detail the development of the new research requirements, the utilization of post-doctoral research fellows to support the scholarly activity requirement laid out by the ACGME, and potential measures of performance and success

Two-Stage, Extreme Albitization of A-type Granites from Rajasthan, NW India

Albitization is a common process during which hydrothermal fluids convert plagioclase and/or K-feldspar into nearly pure albite; however, its specific mechanism in granitoids is not well understood. The c. 1700 Ma A-type metaluminous ferroan granites in the Khetri complex of Rajasthan, NW India, have been albitized to a large extent by two metasomatic fronts, an initial transformation of oligoclase to nearly pure albite and a subsequent replacement of microcline by albite, with sharp contacts between the microcline-bearing and microcline-free zones. Albitization has bleached the original pinkish grey granite and turned it white. The mineralogical changes include transformation of oligoclase (∼An12) and microcline (∼Or95) to almost pure albite (∼An0·5-2), amphibole from potassian ferropargasite (XFe 0·84-0·86) to potassic hastingsite (XFe 0·88-0·97) and actinolite (XFe 0·32-0·67), and biotite from annite (XFe 0·71-0·74) to annite (XFe 0·90-0·91). Whole-rock isocon diagrams show that, during albitization, the granites experienced major hydration, slight gain in Si and major gain in Na, whereas K, Mg, Fe and Ca were lost along with Rb, Ba, Sr, Zn, light rare earth elements and U. Whole-rock Sm-Nd isotope data plot on an apparent isochron of 1419 ± 98 Ma and reveal significant disturbance and at least partial resetting of the intrusion age. Severe scatter in the whole-rock Rb-Sr isochron plot reflects the extreme Rb loss in the completely albitized samples, effectively freezing 87Sr/86Sr ratios in the albite granites at very high values (0·725-0·735). This indicates either infiltration of highly radiogenic Sr from the country rock or, more likely, radiogenic ingrowth during a considerable time lag (estimated to be at least 300 Myr) between original intrusion and albitization. The albitization took place at ∼350-400°C. It was caused by the infiltration of an ascending hydrothermal fluid that had acquired high Na/K and Na/Ca ratios during migration through metamorphic rocks at even lower temperatures in the periphery of the plutons. Oxygen isotope ratios increase from δ18O = 7‰ in the original granite to values of 9-10‰ in completely albitized samples, suggesting that the fluid had equilibrated with surrounding metamorphosed crust. A metasomatic model, using chromatographic theory of fluid infiltration, explains the process for generating the observed zonation in terms of a leading metasomatic front where oligoclase of the original granite is converted to albite, and a second, trailing front where microcline is also converted to albite. The temperature gradients driving the fluid infiltration may have been produced by the high heat production of the granites themselves. The confinement of the albitized granites along the NE-SW-trending Khetri lineament and the pervasive nature of the albitization suggest that the albitizing fluids possibly originated during reactivation of the lineament. More generally, steady-state temperature gradients induced by the high internal heat production of A-type granites may provide the driving force for similar metasomatic and ore-forming processes in other highly enriched granitoid bodie

Unlocking the Potential of Artificial Intelligence (AI) for Healthcare

This book chapter examines the potential of artificial intelligence (AI) to improve healthcare. AI has become increasingly prominent in healthcare, providing the capability to automate tasks, analyze large patient data sets, and deliver quicker and more cost-effective healthcare. We focus on its various applications in healthcare including vital sign monitoring, glycemic control, radiology, and emergency room triage with point of care ultrasound (POCUS). We also address Ai’s ethical, legal, and privacy implications in healthcare such as data protection and safeguarding patient privacy. Finally, we explore the potential of AI in healthcare improvement in the future and investigate the current trends, opportunities, and evolving threats posed by AI in healthcare, as well as its implications for human-AI interfacing and job security. This book chapter provides an essential and comprehensive overview of the potential of AI in healthcare, providing a valuable resource for healthcare professionals and researchers in the field

Patient Safety: Preventing Patient Harm and Building Capacity for Patient Safety

Patient safety is a global public health concern. It is a health care discipline with ever evolving advancement and complexity resulting in consequential rise in patient harm. Since the pandemic, patient safety has been threatened even more by laying bare the inadequacies of health systems. Many unsafe care practices, risks, and errors contribute to patient harm and overall economic burden. These include medical, diagnostic, and radiation errors, healthcare associated infections, unsafe surgical procedures and transfusion practices, sepsis, venous thromboembolism, and falls. Although patient safety has become an integral part of the healthcare delivery model and resources have been dedicated towards it, much still needs to be achieved. An attitude of inclusivity for all care teams and anyone in contact with the patient, including the patients themselves, would enhance patient safety. Incorporating this attitude from educational infancy will allow for better identification of medical errors and inculcate critical analysis of process improvement. Implementing the ‘Just Culture’ by health care organizations can build the infrastructure to eliminate avoidable harm. To reduce avoidable harm and improve safety, a constant flow of information and knowledge should be available to mitigate the risks. Lastly, proper communication and effective leadership can play an imperative role to engage stakeholders and reduce harm

Starting New Accreditation Council for Graduate Medical Education (ACGME) Residency Programs in a Teaching Hospital

Starting a new ACGME approved residency program can positively impact patient care, medical education, hospital operations, and the community as whole. This requires a significant amount of commitment, time, and preparation. The initial application and accreditation process should start early and requires a thorough understanding on the ACGME requirements. Building a new residency program involves collaboration among various stakeholders, starting with the teaching hospital, ACGME, and the Center of Medicare and Medicaid services (CMS). It is prudent to also consider the operational and logistical issues such as budget, faculty and administrative staff hire, faculty time for administrative duties, and educational space for faculty and residents. It is vital to recognize how the institution’s strengths and weaknesses match up to these requirements. A robust educational and clinical curriculum in line with ACGME’s core competencies and useful educational collaboration among various programs is critical for effective program. Recruiting and developing the appropriate faculty members is another important aspect for a successful program. The final challenge is recruiting residents that will fit well into the new residency program. Lastly, we discuss the challenges and tips to mitigate the risks of disappointment in the process of starting and creating a flagship residency program

Shifting the limits in wheat research and breeding using a fully annotated reference genome

Introduction: Wheat (Triticum aestivum L.) is the most widely cultivated crop on Earth, contributing about a fifth of the total calories consumed by humans. Consequently, wheat yields and production affect the global economy, and failed harvests can lead to social unrest. Breeders continuously strive to develop improved varieties by fine-tuning genetically complex yield and end-use quality parameters while maintaining stable yields and adapting the crop to regionally specific biotic and abiotic stresses. Rationale: Breeding efforts are limited by insufficient knowledge and understanding of wheat biology and the molecular basis of central agronomic traits. To meet the demands of human population growth, there is an urgent need for wheat research and breeding to accelerate genetic gain as well as to increase and protect wheat yield and quality traits. In other plant and animal species, access to a fully annotated and ordered genome sequence, including regulatory sequences and genome-diversity information, has promoted the development of systematic and more time-efficient approaches for the selection and understanding of important traits. Wheat has lagged behind, primarily owing to the challenges of assembling a genome that is more than five times as large as the human genome, polyploid, and complex, containing more than 85% repetitive DNA. To provide a foundation for improvement through molecular breeding, in 2005, the International Wheat Genome Sequencing Consortium set out to deliver a high-quality annotated reference genome sequence of bread wheat. Results: An annotated reference sequence representing the hexaploid bread wheat genome in the form of 21 chromosome-like sequence assemblies has now been delivered, giving access to 107,891 high-confidence genes, including their genomic context of regulatory sequences. This assembly enabled the discovery of tissue- and developmental stage–related gene coexpression networks using a transcriptome atlas representing all stages of wheat development. The dynamics of change in complex gene families involved in environmental adaptation and end-use quality were revealed at subgenome resolution and contextualized to known agronomic single-gene or quantitative trait loci. Aspects of the future value of the annotated assembly for molecular breeding and research were exemplarily illustrated by resolving the genetic basis of a quantitative trait locus conferring resistance to abiotic stress and insect damage as well as by serving as the basis for genome editing of the flowering-time trait. Conclusion: This annotated reference sequence of wheat is a resource that can now drive disruptive innovation in wheat improvement, as this community resource establishes the foundation for accelerating wheat research and application through improved understanding of wheat biology and genomics-assisted breeding. Importantly, the bioinformatics capacity developed for model-organism genomes will facilitate a better understanding of the wheat genome as a result of the high-quality chromosome-based genome assembly. By necessity, breeders work with the genome at the whole chromosome level, as each new cross involves the modification of genome-wide gene networks that control the expression of complex traits such as yield. With the annotated and ordered reference genome sequence in place, researchers and breeders can now easily access sequence-level information to precisely define the necessary changes in the genomes for breeding programs. This will be realized through the implementation of new DNA marker platforms and targeted breeding technologies, including genome editing

From Genomes to GENE-omes: Exome Sequencing Concept and Applications in Crop Improvement

Exome sequencing represents targeted capture and sequencing of 1–2% of ‘high-value genomic regions’ (subset of the genome) which are enriched for functional variants and harbors low level of repetitive regions. We discuss here an overview of exome sequencing, ways to approach plant exomes, and advantages and applicability of this powerful approach in deciphering functional regions of genomes. Though initially this approach was developed as an alternative to whole genome sequencing (WGS), but the multitude of benefits conferred by sequence capture via hybridization approaches created a niche for itself to solve many of biological riddles, particularly for resolving phylogenetic distances. The technique has also proved to be successful in understanding the basis of natural and induced molecular variation, marker development and developing genomic resources for complex, wild and non-model species, which are still intractable for WGS efforts. Thus, with profound applications of this powerful sequencing strategy, near future is expected to witness a collective expansion of both techniques, i.e., sequence capture via hybridization for evolutionary and ecological research and WGS approaches for its universal accessibility

COMPARATIVE EVALUATION OF EFFICACY OF GINGIVAL RETRACTION USING CHEMICAL AND MECHANICAL METHODS: AN IN VIVO STUDY

 Objective: The purpose of this in vivo study was to compare and evaluate the clinical efficacy of two gingival retraction systems; Ultrapak and Traxodent, on the basis of the amount of gingival retraction achieved in vertical and horizontal direction and their hemorrhage control. Methods: A total of 60 subjects were selected requiring fixed prosthesis. The two gingival retraction systems were used on the prepared abutments randomly. The vertical gingival retraction was measured before and after retraction using flexible measuring strip with 0.5 mm grading. The horizontal retraction was measured on the casts poured in polysilicone impressions made before the retraction and after retraction. Results: Statistically significant difference (p<0.05) was found between the amount of the retraction (vertical and horizontal) achieved by Ultrapak as compared to Traxodent. However, in achieving hemostasis Traxodent showed better efficiency than Ultrapak (p<0.05). Conclusion: The mean retraction width and depth achieved with retraction cord (Ultrapak) was significantly greater when compared with retraction paste. Although retraction paste (Traxodent) showed bleeding index significantly less when compared to that of retraction cord (Ultrapak)

Family related factors associated with caries prevalence in the primary dentition of five-year-old children

Background: Habits formed in childhood dictate lifestyle choices made as adults. These encompass both oral hygiene and dietary habits which in turn affect dental caries status. Children largely acquire these habits from modeling/observing parents and other family members. Aim: The purpose of this study was to assess the caries status of 5-year-olds, and evaluate associations between dental caries and family-related factors. Materials and Methods: A cohort of 400 children were examined for dental caries using the WHO criteria. Parents were interviewed using a self-structured questionnaire to collect data with regard to variables under evaluation. Statistical analysis: Collected data was subjected to descriptive analysis using the SPSS 12.0 version. Risk factor association with dental caries was investigated using a stepwise logistic regression analysis with P-values 0 were: Mother with low basic education (OR = 1.3), higher number of siblings (OR = 1.4), high snacking frequency (OR = 2.0), parental inability to control sugar consumption (OR = 1.0) parental laxness about the child′s tooth brushing (OR = 1.5), parents brushing their own teeth less than twice daily (OR= 2.0) and unassisted brushing by the child (OR = 1.8). Conclusion: It is thus mandatory to focus on parents′ education level, attitudes and family-structure when planning preventive programs for young children