Patient Care Advocacy Through Electronic Communication

Patient advocacy is a primary role of the Certified Registered Nurse Anesthetist (CRNA). While engaged in the legislative process, CRNAs have failed to materialize significant gains in political potency on a national scale. This project involved the development of prototype software for mobile communication devices to augment the CRNA community’s ability to advocate for patients in the healthcare policy arenas. After a demonstration of the software to key leaders of the American Association of Nurse Anesthetists (AANA), an anonymous survey was distributed to the AANA executive administrators. All six executives in attendance for the demonstration of the software completed and returned a qualitative survey. The survey was designed for a critique of the developed software. The results of the survey conveyed a strong interest in the prototype and a plan for further development of the software. Several functions of the software were regarded by the AANA executives as essentials for future iterations of the application

The association between the food environment and weight status among eastern North Carolina youth

Objective: To examine associations between various measures of the food environment and BMI percentile among youth. Design: Cross-sectional, observational. Setting: Pitt County, eastern North Carolina. Subjects:We extracted the electronic medical records for youth receiving well child check-ups from January 2007 to June 2008. We obtained addresses for food venues from two secondary sources and ground-truthing. A geographic information systems database was constructed by geocoding home addresses of 744 youth and food venues. We quantified participants\u27 accessibility to food venues by calculating \u27coverage\u27, number of food venues in buffers of 0●25, 0●5, 1 and 5 miles (0●4, 0●8, 1●6 and 8●0 km) and by calculating \u27proximity\u27 or distance to the closest food venue. We examined associations between BMI percentile and food venue accessibility using correlation and regression analyses. Results:There were negative associations between BMI percentile and coverage of farmers\u27 markets/produce markets in 0●25 and 0●5 mile Euclidean and 0●25, 0●5 and 1 mile road network buffers. There were positive associations between BMI percentile coverage of fast-food and pizza places in the 0●25 mile Euclidean and network buffers. In multivariate analyses adjusted for race, insurance status and rural/urban residence, proximity (network distance) to convenience stores was negatively associated with BMI percentile and proximity to farmers\u27 markets was positively associated with BMI percentile. Conclusions: Accessibility to various types of food venues is associated with BMI percentile in eastern North Carolina youth. Future longitudinal work should examine correlations between accessibility to and use of traditional and non-traditional food venues

A microfluidics and agent-based modeling framework for investigating spatial organization in bacterial colonies: The case of Pseudomonas Aeruginosa amd H1-type VI secretion interactions

The factors leading to changes in the organization of microbial assemblages at fine spatial scales are not well characterized or understood. However, they are expected to guide the succession of community development and function toward specific outcomes that could impact human health and the environment. In this study, we put forward a combined experimental and agent-based modeling framework and use it to interpret unique spatial organization patterns of H1-Type VI secretion system (T6SS) mutants of P. aeruginosa under spatial confinement. We find that key parameters, such as T6SS-mediated cell contact and lysis, spatial localization, relative species abundance, cell density and local concentrations of growth substrates and metabolites are influenced by spatial confinement. The model, written in the accessible programming language NetLogo, can be adapted to a variety of biological systems of interest and used to simulate experiments across a broad parameter space. It was implemented and run in a high-throughput mode by deploying it across multiple CPUs, with each simulation representing an individual well within a high-throughput microwell array experimental platform. The microfluidics and agent-based modeling framework we present in this paper provides an effective means by which to connect experimental studies in microbiology to model development. The work demonstrates progress in coupling experimental results to simulation while also highlighting potential sources of discrepancies between real-world experiments and idealized models

A Discrete and Distributed Steady Blowing Application on a High Reynolds Number Semispan Supercritical Wing Configuration

The FAST-MAC circulation control model was modified to test an array of steady and unsteady actuators at realistic flight Reynolds numbers in the National Transonic Facility at the NASA Langley Research Center. Previous experiments in the FAST-MAC test series used a fullspan tapered slot, and that configuration is used as a baseline for performance and weight flow requirements. The goal of the latest experiment was to reduce the weight flow required to achieve comparable performance established by the baseline FAST-MAC data. Thirty-nine interchangeable actuator cartridges of various designs were mounted into the FAST-MAC model where the exiting jet was directed over a 15% chord simple hinged-flap. These two types of actuators were fabricated using rapid prototype techniques and their design performance was optimized for a transonic cruise configuration having a 0 flap deflection. The steady actuators were found to provide an off-design drag reduction of 5.5%, nearly equaling the drag reduction of the fullspan tapered slot configuration, but with a 69% weight flow reduction. This weight flow savings is similar to the sweeping jet actuators, but with better drag performance

Ecological Modeling of Aedes aegypti (L.) Pupal Production in Rural Kamphaeng Phet, Thailand

Background - Aedes aegypti (L.) is the primary vector of dengue, the most important arboviral infection globally. Until an effective vaccine is licensed and rigorously administered, Ae. aegypti control remains the principal tool in preventing and curtailing dengue transmission. Accurate predictions of vector populations are required to assess control methods and develop effective population reduction strategies. Ae. aegypti develops primarily in artificial water holding containers. Release recapture studies indicate that most adult Ae. aegypti do not disperse over long distances. We expect, therefore, that containers in an area of high development site density are more likely to be oviposition sites and to be more frequently used as oviposition sites than containers that are relatively isolated from other development sites. After accounting for individual container characteristics, containers more frequently used as oviposition sites are likely to produce adult mosquitoes consistently and at a higher rate. To this point, most studies of Ae. aegypti populations ignore the spatial density of larval development sites. Methodology - Pupal surveys were carried out from 2004 to 2007 in rural Kamphaeng Phet, Thailand. In total, 84,840 samples of water holding containers were used to estimate model parameters. Regression modeling was used to assess the effect of larval development site density, access to piped water, and seasonal variation on container productivity. A varying-coefficients model was employed to account for the large differences in productivity between container types. A two-part modeling structure, called a hurdle model, accounts for the large number of zeroes and overdispersion present in pupal population counts. Findings - The number of suitable larval development sites and their density in the environment were the primary determinants of the distribution and abundance of Ae. aegypti pupae. The productivity of most container types increased significantly as habitat density increased. An ecological approach, accounting for development site density, is appropriate for predicting Ae. aegypti population levels and developing efficient vector control program

Racial, Ethnic, and Socioeconomic Disparities in Multiple Measures of Blue and Green Spaces in the United States

BACKGROUND: Several studies have evaluated whether the distribution of natural environments differs between marginalized and privileged neighborhoods. However, most studies restricted their analyses to a single or handful of cities and used different natural environment measures. OBJECTIVES: We evaluated whether natural environments are inequitably distributed based on socioeconomic status (SES) and race/ethnicity in the contiguous United States. METHODS: We obtained SES and race/ethnicity data (2015–2019) for all U.S. Census tracts. For each tract, we calculated the Normalized Different Vegetation Index (NDVI) for 2020, NatureScore (a proprietary measure of the quantity and quality of natural elements) for 2019, park cover for 2020, and blue space for 1984–2018. We used generalized additive models with adjustment for potential confounders and spatial autocorrelation to evaluate associations of SES and race/ethnicity with NDVI, NatureScore, park cover, and odds of containing blue space in all tracts ([Formula: see text]) and in urban tracts ([Formula: see text]). To compare effect estimates, we standardized NDVI, NatureScore, and park cover so that beta coefficients presented a percentage increase or decrease of the standard deviation (SD). RESULTS: Tracts with higher SES had higher NDVI, NatureScore, park cover, and odds of containing blue space. For example, urban tracts in the highest median household income quintile had higher NDVI [44.8% of the SD (95% CI: 42.8, 46.8)] and park cover [16.2% of the SD (95% CI: 13.5, 19.0)] compared with urban tracts in the lowest median household income quintile. Across all tracts, a lower percentage of non-Hispanic White individuals and a higher percentage of Hispanic individuals were associated with lower NDVI and NatureScore. In urban tracts, we observed weak positive associations between percentage non-Hispanic Black and NDVI, NatureScore, and park cover; we did not find any clear associations for percentage Hispanics. DISCUSSION: Multiple facets of the natural environment are inequitably distributed in the contiguous United States. https://doi.org/10.1289/EHP1116

Antithrombotic Therapy in Patients with Acute Coronary Syndrome in the Intermountain Heart Collaborative Study

Objective. To determine factors associated with single antiplatelet (SAP) or dual antiplatelet (DAP) therapy and anticoagulants (AC) use in hospital and after discharge among patients with acute coronary syndrome (ACS). Methods. We evaluated 5,294 ACS patients in the Intermountain Heart Collaborative Study from 2004 to 2009. Multivariable logistic regressions were used to determine predictors of AC or AP use. Results. In hospital, 99% received an AC, 79% DAP, and 19% SAP; 78% had DAP + AC. Coronary stents were the strongest predictors of DAP use in hospital compared to SAP (P<0.001). After discharge, 77% received DAP, 20% SAP, and 9% AC; 5% had DAP + AC. DAP compared to SAP was less likely for patients on AC (odds ratio [OR] = 0.30, P<0.0001) after discharge. Placement of a stent increased the likelihood of DAP (bare metal: OR = 54.8, P<0.0001; drug eluting: OR = 59.4, P<0.0001). 923 had atrial fibrillation and 337 had a history of venous thromboembolism; these patients had increased use of AC (29% and 40%, resp.). Conclusion. While in-hospital use of AC was nearly universal, postdischarge AC use was rare. Concern for providing the best antithrombotic therapy, while maintaining an acceptable bleeding risk, may explain the selection decisions

Analysis of changing statistical significance from .05 to .005 in foot and ankle randomized controlled trials

Background: Misinterpretation of p-values in RCTs is extremely problematic since they are the core basis for high levels of recommendation in clinical practice guidelines, especially Orthopaedics. Benjamin et al. proposed a universal protocol change, moving statistical significance from a p-value of .05 to .005 to combat the misinterpretation that is happening in medical literature. In this study, we are looking to evaluate the effect of the protocol suggested by Benjamin et al. on foot and ankle-related RCTs in the top 3 Foot and Ankle-related journals.Methods: We conducted a Pubmed search looking at studies published from January 1st, 2016 to November 10, 2021, in the following three journals; Foot and Ankle International, Journal of Foot and Ankle Surgery, and Foot & Ankle International. The inclusion criteria for the study were RCTs published in the above journals with specifically stated primary endpoints. If a study has multiple primary endpoints, all were included. Exclusion criteria were any study that was not prospective and randomized by design, also any study that did not state primary endpoints was excluded. Two authors extracted the data using a pilot-tested Google form, any disagreements or questions were resolved by published methodologic orthopaedic authors.Results: Of the 222 endpoints, 101 endpoints (45.5%; 101/222) were at or below the .05 threshold while 121 endpoints (54.5%; 121/222) were above the .05 threshold. We also found that 59 endpoints (26.6%; 59/222) were below .005.Conclusion: Our results suggest that changing the threshold for statistical significance from .05 to .005 in foot and ankle RCTs would heavily alter literature published in the field. By implementing this methodology, it is a promising measure to be able to increase RCT quality until a more substantial solution can be found. With that being said, caution must be taken when interpreting our results, also requiring further evaluation