Healthcare Performance Improvement and High Reliability: A Best Practice Methodology

Healthcare Performance Improvement (HPI) improves reliability in healthcare by helping organizations achieve and sustain high performance outcomes in safety, quality, and satisfaction. Safety is the core value of the healthcare organization. Yet safety – protection from harm – doesn’t just happen. HPI provides a method for reducing the Serious Safety Event Rate through translating safety from a core value to specific behavior expectations of leaders, staff, and physicians. The HPI method and techniques are based on the best practices of high-reliability organizations (such as nuclear power and aviation) that get it right in safety. While healthcare has focused on traditional process improvement as a means to better outcomes, high-reliability organizations recognize that optimizing outcomes requires a concurrent focus on human behavior accountability. Our method focuses on preventing human errors and detecting and correcting system weaknesses that can lead to events of harm and unwanted outcomes

Accessing thermoplastic processing windows in metallic glasses using rapid capacitive discharge

The ability of the rapid-capacitive discharge approach to access optimal viscosity ranges in metallic glasses for thermoplastic processing is explored. Using high-speed thermal imaging, the heating uniformity and stability against crystallization of Zr_(35)Ti_(30)Cu_7.5Be_(27.5) metallic glass heated deeply into the supercooled region is investigated. The method enables homogeneous volumetric heating of bulk samples throughout the entire supercooled liquid region at high rates (~10^5 K/s) sufficient to bypass crystallization throughout. The crystallization onsets at temperatures in the vicinity of the “crystallization nose” were identified and a Time-Temperature-Transformation diagram is constructed, revealing a “critical heating rate” for the metallic glass of ~1000 K/s. Thermoplastic process windows in the optimal viscosity range of 10^0–10^4 Pa·s are identified, being confined between the glass relaxation and the eutectic crystallization transition. Within this process window, near-net forging of a fine precision metallic glass part is demonstrated

Designing a fully compensated half-metallic ferrimagnet

Recent experimental work on Mn2RuxGa demonstrates its potential as a compensated ferrimagnetic half-metal (CFHM). Here we present a set of high-throughput ab initio density functional theory calculations and detailed experimental characterisation, that enable us to correctly describe the nominal Mn2RuxGa thin films, in particular with regard to site-disorder and defects. We then construct models that accurately capture all the key features of the Mn-Ru-Ga system, including magnetic compensation and the spin gap at the Fermi level. We find that electronic doping is neccessary, which is achieved with a Mn/Ga ratio smaller than two. Our study shows how composition and substrate-induced biaxial strain can be combined to design a ferrimagnetic half-metal with a compensation point close to room temperature

Effects of D-amino acid oxidase inhibition on memory performance and long-term potentiation in vivo

N-methyl-d-aspartate receptor (NMDAR) activation can initiate changes in synaptic strength, evident as long-term potentiation (LTP), and is a key molecular correlate of memory formation. Inhibition of d-amino acid oxidase (DAAO) may increase NMDAR activity by regulating d-serine concentrations, but which neuronal and behavioral effects are influenced by DAAO inhibition remain elusive. In anesthetized rats, extracellular field excitatory postsynaptic potentials (fEPSPs) were recorded before and after a theta frequency burst stimulation (TBS) of the Schaffer collateral pathway of the CA1 region in the hippocampus. Memory performance was assessed after training with tests of contextual fear conditioning (FC, mice) and novel object recognition (NOR, rats). Oral administration of 3, 10, and 30 mg/kg 4H-furo[3,2-b]pyrrole-5-carboxylic acid (SUN) produced dose-related and steady increases of cerebellum d-serine in rats and mice, indicative of lasting inhibition of central DAAO. SUN administered 2 h prior to training improved contextual fear conditioning in mice and novel object recognition memory in rats when tested 24 h after training. In anesthetized rats, LTP was established proportional to the number of TBS trains. d-cycloserine (DCS) was used to identify a submaximal level of LTP (5× TBS) that responded to NMDA receptor activation; SUN administered at 10 mg/kg 3–4 h prior to testing similarly increased in vivo LTP levels compared to vehicle control animals. Interestingly, in vivo administration of DCS also increased brain d-serine concentrations. These results indicate that DAAO inhibition increased NMDAR-related synaptic plasticity during phases of post training memory consolidation to improve memory performance in hippocampal-dependent behavioral tests

Partial cooperative unfolding in proteins as observed by hydrogen exchange mass spectrometry

This is an Accepted Manuscript of an article published by Taylor & Francis in International Reviews in Physical Chemistry on 2013-1-1, available online: http://www.tandfonline.com/10.1080/0144235X.2012.751175.Many proteins do not exist in a single rigid conformation. Protein motions, or dynamics, exist and in many cases are important for protein function. The analysis of protein dynamics relies on biophysical techniques that can distinguish simultaneously existing populations of molecules and their rates of interconversion. Hydrogen exchange (HX) detected by mass spectrometry (MS) is contributing to our understanding of protein motions by revealing unfolding and dynamics on a wide timescale, ranging from seconds to hours to days. In this review we discuss HX MS-based analyses of protein dynamics, using our studies of multi-domain kinases as examples. Using HX MS, we have successfully probed protein dynamics and unfolding in the isolated SH3, SH2 and kinase domains of the c-Src and Abl kinase families, as well as the role of inter- and intra-molecular interactions in the global control of kinase function. Coupled with high-resolution structural information, HX MS has proved to be a powerful and versatile tool for the analysis of the conformational dynamics in these kinase systems, and has provided fresh insight regarding the regulatory control of these important signaling proteins. HX MS studies of dynamics are applicable not only to the proteins we illustrate here, but to a very wide range of proteins and protein systems, and should play a role in both classification of and greater understanding of the prevalence of protein motion

Opioid initiation and injection transition in rural northern New England: A mixed-methods approach

BACKGROUND: In rural northern New England, located in the northeastern United States, the overdose epidemic has accelerated with the introduction of fentanyl. Opioid initiation and transition to opioid injection have been studied in urban settings. Little is known about opioid initiation and transition to injection drug use in rural northern New England. METHODS: This mixed-methods study characterized opioid use and drug injection in 11 rural counties in Massachusetts, Vermont, and New Hampshire between 2018 and 2019. People who use drugs completed audio computer-assisted self-interview surveys on substance use and risk behaviors (n = 589) and shared personal narratives through in-depth interviews (n = 22). The objective of the current study is to describe initiation of opioid use and drug injection in rural northern New England. RESULTS: Median age of first injection was 22 years (interquartile range 18-28 years). Key themes from in-depth interviews that led to initiating drug injection included normalization of drug use in families and communities, experiencing trauma, and abrupt discontinuation of an opioid prescription. Other factors that led to a transition to injecting included lower cost, increased effect/ rush, greater availability of heroin/ fentanyl, and faster relief of withdrawal symptoms with injection. CONCLUSIONS: Trauma, normalization of drug use, over-prescribing of opioids, and abrupt discontinuation challenge people who use drugs in rural northern New England communities. Inadequate opioid tapering may increase transition to non-prescribed drug use. The extent and severity of traumatic experiences described highlights the importance of enhancing trauma-informed care in rural areas

An Analysis of Warm-Up Strategies at a Cross-Country Skiing National Championship

Purpose: To provide a descriptive analysis of the warm-up (WU) strategies employed by cross-country skiers prior to distance and sprint competitions at a national championship and to compare the skiers’ planned and executed WUs prior to the respective competitions. Methods: Twenty-one national- and international-level skiers (11 women and 10 men) submitted WU plans prior to the distance and sprint competitions, and after the competitions, reported any deviations from the plans. Skiers used personal monitors to record heart rate (HR) during WU, races, and cooldown. Quantitative statistical analyses were conducted on WU durations, durations in HR-derived intensity zones, and WU loads. Qualitative analyses were conducted on skiers’ WU plans and their reasons for deviating from the plans. Results: Skiers’ planned WUs were similar in content and planned time in HR-derived intensity zones for both the distance and sprint competitions. However, 45% of the women and 20% of the men reported that their WU was not carried out as planned, with reasons detailed as being due to incorrect intensities and running out of time. WU activities including skiing across variable terrain, muscle-potentiating exercises, and heat-maintenance strategies were missing from the skiers’ planned routines. Conclusions: Skiers favored a long, traditional WU approach for both the sprint and distance events, performing less high-intensity and more moderate-intensity exercise during their WUs than planned. In addition, elements likely relevant to successful performance in cross-country skiing were missing from WU plans

Life After Sport: Athletic Career Transition and Transferable Skills

Permission to include this article granted by Journal of ExcellenceAthletes transitioning out of sport are faced with many obstacles. Well-trained counselors have the appropriate skills to assist athletes through athletic career transition. An examination of the literature focused on career retirement and transferable skills lead to the development of intervention recommendations for athletes transitioning out of sport. Treatment recommendations include psycho-educational and cognitive behavioural interventions that focus on the emotions associated with transitioning from sport as well as an emphasis on transferable skills.Ye