Patient experience in the behavioral health setting: Key best practices throughout an organizational journey

NewYork-Presbyterian/Westchester Division, a clinical affiliate of Weill Cornell Medicine, is a 260-bed hospital providing inpatient and outpatient behavioral health care for children, adolescents, adults and older adults. From 2004-2010 the hospital’s patient experience scores on the Press Ganey® Inpatient Psychiatry Survey improved from the 14th to 53rd percentile nationally. We primarily attribute this to joining the Planetree® Affilliate Network. Planetree is a mission based not-for-profit organization that partners with healthcare organizations around the world and across the care continuum to represent the patient voice and advance how professional caregivers engage with patients and families. In 2011, hourly rounding was redesigned and tailored for the behavioral health setting. This initiative, coupled with regular Planetree education and an ongoing commitment by staff and the healthcare system to improving patient experience, contributed to a further improvement, with the hospital moving to the top ten percent of psychiatric hospitals nationally in the Press Ganey survey. In this paper, we describe the organizational journey that led to these improvements and identify learning for other hospitals, particularly in a behavioral healthcare setting

Binary classification of spoken words with passive elastic metastructures

Many electronic devices spend most of their time waiting for a wake-up event: pacemakers waiting for an anomalous heartbeat, security systems on alert to detect an intruder, smartphones listening for the user to say a wake-up phrase. These devices continuously convert physical signals into electrical currents that are then analyzed on a digital computer -- leading to power consumption even when no event is taking place. Solving this problem requires the ability to passively distinguish relevant from irrelevant events (e.g. tell a wake-up phrase from a regular conversation). Here, we experimentally demonstrate an elastic metastructure, consisting of a network of coupled silicon resonators, that passively discriminates between pairs of spoken words -- solving the wake-up problem for scenarios where only two classes of events are possible. This passive speech recognition is demonstrated on a dataset from speakers with significant gender and accent diversity. The geometry of the metastructure is determined during the design process, in which the network of resonators ('mechanical neurones') learns to selectively respond to spoken words. Training is facilitated by a machine learning model that reduces the number of computationally expensive three-dimensional elastic wave simulations. By embedding event detection in the structural dynamics, mechanical neural networks thus enable novel classes of always-on smart devices with no standby power consumption.Comment: 13 pages, 9 figure

Amphioxus functional genomics and the origins of vertebrate gene regulation.

Vertebrates have greatly elaborated the basic chordate body plan and evolved highly distinctive genomes that have been sculpted by two whole-genome duplications. Here we sequence the genome of the Mediterranean amphioxus (Branchiostoma lanceolatum) and characterize DNA methylation, chromatin accessibility, histone modifications and transcriptomes across multiple developmental stages and adult tissues to investigate the evolution of the regulation of the chordate genome. Comparisons with vertebrates identify an intermediate stage in the evolution of differentially methylated enhancers, and a high conservation of gene expression and its cis-regulatory logic between amphioxus and vertebrates that occurs maximally at an earlier mid-embryonic phylotypic period. We analyse regulatory evolution after whole-genome duplications, and find that-in vertebrates-over 80% of broadly expressed gene families with multiple paralogues derived from whole-genome duplications have members that restricted their ancestral expression, and underwent specialization rather than subfunctionalization. Counter-intuitively, paralogues that restricted their expression increased the complexity of their regulatory landscapes. These data pave the way for a better understanding of the regulatory principles that underlie key vertebrate innovations

Transcriptomic Signatures of Ash (Fraxinus spp.) Phloem

Ash (Fraxinus spp.) is a dominant tree species throughout urban and forested landscapes of North America (NA). The rapid invasion of NA by emerald ash borer (Agrilus planipennis), a wood-boring beetle endemic to Eastern Asia, has resulted in the death of millions of ash trees and threatens billions more. Larvae feed primarily on phloem tissue, which girdles and kills the tree. While NA ash species including black (F. nigra), green (F. pennsylvannica) and white (F. americana) are highly susceptible, the Asian species Manchurian ash (F. mandshurica) is resistant to A. planipennis perhaps due to their co-evolutionary history. Little is known about the molecular genetics of ash. Hence, we undertook a functional genomics approach to identify the repertoire of genes expressed in ash phloem.Using 454 pyrosequencing we obtained 58,673 high quality ash sequences from pooled phloem samples of green, white, black, blue and Manchurian ash. Intriguingly, 45% of the deduced proteins were not significantly similar to any sequences in the GenBank non-redundant database. KEGG analysis of the ash sequences revealed a high occurrence of defense related genes. Expression analysis of early regulators potentially involved in plant defense (i.e. transcription factors, calcium dependent protein kinases and a lipoxygenase 3) revealed higher mRNA levels in resistant ash compared to susceptible ash species. Lastly, we predicted a total of 1,272 single nucleotide polymorphisms and 980 microsatellite loci, among which seven microsatellite loci showed polymorphism between different ash species.The current transcriptomic data provide an invaluable resource for understanding the genetic make-up of ash phloem, the target tissue of A. planipennis. These data along with future functional studies could lead to the identification/characterization of defense genes involved in resistance of ash to A. planipennis, and in future ash breeding programs for marker development

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

A Preliminary Study of the Effects of Liposuction Technique on Adipose-Derived Stem Cell Viability and Abundance

The clinical use of stem cells provides undeniable advantages as they can substitute for injured cells, tissues, and potentially organs in the human body. Recent studies using adipose-derived stem cells (ADSCs) have shown promise for adult stem cells as a rich, clinically- relevant population. The method of lipoplasty and its effects on pluripotency of the stem cells is an important experimental question. In this study we demonstrate that harvesting ADSCs using water-jet assisted liposuction (Body Jet) in combination with the laser assisted liposuction (SmartLipo) technique yields higher quantities of viable ADSCs compared to BodyJet liposuction alone. The ability of cells derived from cryostored lipoaspirate to differentiate along the chondrocyte and osteoblast lineages was also examined. Cells isolated from cryopreserved lipoaspirate collected by Body Jet or Body Jet in combination with SmartLipo were compared to a human, mesenchymal ADSC cell-line (PCS-500-011). Utilizing confocal microscopy, we demonstrate that following isolation from frozen lipoaspirate, ADSCs could differentiate along chondrocyte and osteoblast lineages. This innovative study provides the first data to demonstrate differences in ADSC populations retrieved based on lipoplasty technique utilized. Potential implications include better informed clinician choice of lipoplasty technique for those intending to further utilize ADSCs for additional clinical applications

In‐Sensor Passive Speech Classification with Phononic Metamaterials

Mitigating the energy requirements of artificial intelligence requires novel physical substrates for computation. Phononic metamaterials have vanishingly low power dissipation and hence are a prime candidate for green, always-on computers. However, their use in machine learning applications has not been explored due to the complexity of their design process. Current phononic metamaterials are restricted to simple geometries (e.g., periodic and tapered) and hence do not possess sufficient expressivity to encode machine learning tasks. A non-periodic phononic metamaterial, directly from data samples, that can distinguish between pairs of spoken words in the presence of a simple readout nonlinearity is designed and fabricated, hence demonstrating that phononic metamaterials are a viable avenue towards zero-power smart devices.ISSN:1616-3028ISSN:1616-301

Is there gender bias when creative directors judge advertising? Name cue effect in ad evaluation

A lack of women in creative departments has been documented in previous research. These departments are seen as a male fraternity subculture in advertising agencies, where women experience many difficulties in their career progress. One of these drawbacks is gender bias in the selection of ideas' process. Male creative directors are believed to promote ideas created by men within a homosocial environment. This female perception, that emerged from previous qualitative research, is studied experimentally for the first time. Almost 90 advertising creative directors and higher level positions, assessed ads created by students in an advertising university course. In the current study we explore the effects of ad gender authorship. Results revealed an absence of gender bias based on ad name cues, neither the gender of the ad creators nor the creatives affected the evaluations. The findings are discussed and future research is proposed