Implementation of a postoperative handoff protocol

Background: Standardised handoff protocols have become necessary patient safety tools in the perioperative venue. In this study, the authors took a validated standardised perioperative handoff protocol and implemented it into their institution to improve the perioperative handoff communications from the cardiac operating theatres to the ICU.Methods: This was a prospective, unblinded cross-sectional study. During a 6-week pre-intervention phase, 30 perioperative handoffs were observed and data were collected. Then a new structured hand-off protocol was implemented for one month, which focused on training all participating healthcare providers. This was followed by a post-intervention audit consisting of 30 operating room theatre-to-ICU handoffs using the same methodology as the pre-intervention period.Results: Overall attendance significantly increased from 20 to 86.7%. The percentage of parallel conversations decreased from 100% pre-intervention to 60% post-intervention (p < 0.0001). The mean number of interruptions of the anaesthesiology handoff report decreased from 3.37 to 0.77 (p < 0.0001) and of the surgery report from 1.84 to 0.27 (p < 0.0001). Information-sharing scores improved among all handoff attendees with the Overall Information Sharing Score (OISS) increasing from 51.47 to 88.24% (p < 0.0001).Conclusions: The implementation of a perioperative handoff protocol resulted in a drastic improvement in attendance, decrease in the number of interruptions, and improved information sharing. Future research should focus on patient-specific outcomes.Keywords: handoffs, handover, ICU handoff, patient safety, perioperative handof

A novel mutation in the Choroideremia gene in a Turkish family.

Choroideremia is an X-linked recessive genetic disorder caused by mutations in the CHM gene. It is a rare retinal dystrophy that manifests as nyctalopia and vision loss, progressing to blindness in later stages. We report a 21-year Turkish man who presented with nyctalopia for the past 4-5 years. His mother and maternal grandmother had similar, but less pronounced complaints. Fundus examination revealed pigmentary changes and retinal atrophy in both eyes. Optical coherence tomography showed outer retinal loss, with central island of preserved autofluorescence surrounded by absent autofluorescence on fundus autofluorescence examination. Goldmann visual fields were constricted. Microperimetry detected retinal sensitivity losses, and full-field electroretinogram demonstrated extinguished cone responses. Genetic analysis revealed a novel nonsense mutation in the CHM gene, namely p.E480X: c.1438G \u3eT. The mutation causes a premature stop codon in exon 12. This is the first report of a G1438T mutation resulting in an E480X premature stop in the CHM gene

Light cone QCD sum rules study of the semileptonic heavy ΞQ\Xi_{Q} and ΞQ′\Xi'_{Q} transitions to Ξ\Xi and Σ\Sigma baryons

The semileptonic decays of heavy spin--1/2, $\Xi_{b(c)}$ and $\Xi'_{b(c)}$ baryons to the light spin-- 1/2, $\Xi$ and $\Sigma$ baryons are investigated in the framework of the light cone QCD sum rules. In particular, using the most general form of the interpolating currents for the heavy baryons as well as the distribution amplitudes of the $\Xi$ and $\Sigma$ baryons, we calculate all form factors entering the matrix elements of the corresponding effective Hamiltonians in full QCD. Having calculated the responsible form factors, we evaluate the decay rates and branching fractions of the related transitions.Comment: 30 Pages, 5 Figures and 18 Table

Diving into the vertical dimension of elasmobranch movement ecology

Knowledge of the three-dimensional movement patterns of elasmobranchs is vital to understand their ecological roles and exposure to anthropogenic pressures. To date, comparative studies among species at global scales have mostly focused on horizontal movements. Our study addresses the knowledge gap of vertical movements by compiling the first global synthesis of vertical habitat use by elasmobranchs from data obtained by deployment of 989 biotelemetry tags on 38 elasmobranch species. Elasmobranchs displayed high intra- and interspecific variability in vertical movement patterns. Substantial vertical overlap was observed for many epipelagic elasmobranchs, indicating an increased likelihood to display spatial overlap, biologically interact, and share similar risk to anthropogenic threats that vary on a vertical gradient. We highlight the critical next steps toward incorporating vertical movement into global management and monitoring strategies for elasmobranchs, emphasizing the need to address geographic and taxonomic biases in deployments and to concurrently consider both horizontal and vertical movements

Chemistry of spring and well waters on Kilauea Volcano, Hawaii, and vicinity

Published and new data for chemical and isotopic samples from wells and springs on Kilauea Volcano and vicinity are presented. These data are used to understand processes that determine the chemistry of dilute meteoric water, mixtures with sea water, and thermal water. Data for well and spring samples of non-thermal water indicate that mixing with sea water and dissolution of rock from weathering are the major processes that determine the composition of dissolved constituents in water. Data from coastal springs demonstrate that there is a large thermal system south of the lower east rift of Kilauea. Samples of thermal water from shallow wells in the lower east rift and vicinity have rather variable chemistry indicating that a number of processes operate in the near surface. Water sampled from the available deep wells is different in composition from the shallow thermal water, indicating that generally there is not a significant component of deep water in the shallow wells. Data for samples from available deep wells show significant gradients in chemistry and steam content of the reservoir fluid. These gradients are interpreted to indicate that the reservoir tapped by the existing wells is an evolving vapor-dominated system

Connecting People: Semantic-Conceptual Modeling for Laws and Regulations

Working on building large scale information systems that have the job to serve their clients in a client friendly way and at the same time have to comply with the rules that regulate their behavior, including their (legal) decision-making processes, we observed that designing these systems is still more an art rather than a result of systematic engineering. We have been working on a method allowing stakeholders to systematically analyze the rules and their meaning (i.e. their effect in practical cases) in such way that it supports systems designers and (legal) experts in making sense out of the legal sources, and use this understanding of the regulatory system at hand when designing information systems that supports both the (administrative) organizations and their clients. In this paper we will elaborate on our proposed analysis approach, show how to systematically use the patterns explicitly but often implicitly available in laws and regulation. The Hohfeld conceptual model is very helpful. The Hohfeld model needs extension in our view and thus we have specified the semantic-conceptual model for Hohfeld as a solid base to add time travel aspects