Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team- Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method for delivering evidence based critical care. Collaborators participated in weekly 1-hour videoconference sessions on high impact topics, monthly quality improvement (QI) coaching sessions, and received extensive additional resources for asynchronous learning. MAIN OUTCOMES AND MEASURES: Outcomes included learner engagement, satisfaction, and number of QI projects initiated by participating teams. RESULTS: Eleven of 13 initial sites participated in the Collaborative from March 2, 2021, to September 29, 2021. A total of 67 learners participated in the Collaborative, including 23 nurses, 22 physicians, 10 pharmacists, nine respiratory therapists, and three nonclinicians. Site attendance among the 11 sites in the 25 videoconference sessions ranged between 82% and 100%, with three sites providing at least one team member for 100% of sessions. The majority reported that topics matched their scope of practice (69%) and would highly recommend the program to colleagues (77%). A total of nine QI projects were initiated across three clinical domains and focused on improving adherence to established critical care practice bundles, reducing nosocomial complications, and strengthening patient- and family-centered care in the ICU. Major factors impacting successful Collaborative engagement included an engaged interprofessional team; an established culture of engagement; opportunities to benchmark performance and accelerate institutional innovation, networking, and acclaim; and ready access to data that could be leveraged for QI purposes. CONCLUSIONS AND RELEVANCE: Use of a virtual platform to establish a learning collaborative to accelerate the identification, dissemination, and implementation of critical care best practices for COVID-19 is feasible. Our experience offers important lessons for future collaborative efforts focused on improving ICU processes of care

Review on pharmaceutical properties and conservation measures of <i style="">Potentilla fulgens</i> Wall. ex Hook. - A medicinal endangered herb of higher Himalaya

298-306Plenteous ethnotherapeutic properties and pharmacological actions have been attributed to Potentilla fulgens Wall. ex Hook. (Family- Rosaceae). It is one of the highly valued indigenous medicinal herbs of higher Himalaya. Biomedical reports have indicated presence of medicinally important chemical constituents represented by polyphenols, tannins, flavonoids and triterpenoids in the genus. Pharmacological studies report that P. fulgens possesses anti-hyperglycemic, hypoglycemic, anti-hyperlipidemic, antitumor, antioxidant, antiinflammatory and antiulcerogenic properties thus supporting its ethnotherapeutic use. In view of immense medicinal importance of the plant, this review aims to coherently discuss the results obtained from several studies on its chemical constituents, pharmacological use, cultivation and conservation strategies

Enviornmentally benign Michael and Claisen Schmidt reaction of aromatic carbonyl compounds by alkaline polyionic resin

1137-1145A regioselective Michael reaction between aryl methyl ketones and α,β-unsaturated compounds has been carried out using basic polyionic resin as a reusable reagent. Results indicate that the reaction proceeds in consecutive manner as double Michael (27-65%) and triple Michael (40-45%) products with overall yields of 55-80%. Moreover, A-2XMP resin has also been applied on Claisen Schmidt condensations of aromatic aldehydes and ketones (acyclic as well as cyclic) under different reaction conditions yielding dehydrated products in 82-94% yield.<b style="mso-bidi-font-weight: normal"> The reactions give an opportunity for easy separation, reusability of polyionic resin and easy purification of products in continuous or multiple processing of organic compounds. </span

Ownership, Foreign Listings, and Market Valuation

We study changes in U.S. institutional ownership and its effects for 83 new listings of Canadian equities on U.S. exchanges. While institutional holdings increase starting four quarters before cross-listing, there is a pronounced spike in the listing quarter. This is consistent with foreign listing being essential to attract major foreign investors. Sorting stocks on the change in institutional ownership associated with cross-listing, we find that stocks with the largest increase in ownership experience (a) permanent increases in their prices; (b) the largest increase in comovement with the U.S. equity index; and (c) the largest increase in local liquidity. These results suggest that ownership plays a critical part in driving price and liquidity changes around cross-listings and in inducing comovement with local stocks

Dysplastic L5-S1 Spondyloptosis in a 3-Year-Old Child: A Case Report and Review of the Literature

A three-year-old girl presented with primary complaint of severe low back pain with radiation to both lower limbs below the knees since 2 months following history of fall and marked restriction of her daily routine activities. After clinicoradiological evaluation she was diagnosed of having dysplastic L5-S1 spondyloptosis. A staged procedure was planned after thorough discussion with her parents. During initial stage she underwent posterior decompression along L5-S1 segment including exposure of bilateral L5 and S1 nerve roots followed by instrumented reduction (L3-S2 5.5 mm pedicle screws) utilizing a rotational-translational technique. No interbody fusion was done at L5-S1 level and inner nuts of bilateral L3, L4, and S2 screws were intentionally kept loose. Subsequently after about symptom-free three-year follow up, she presented with recurrence of symptoms and underwent revision surgery as per initial plan discussed with her parents. Removals of posterior implants were done followed by stabilization with larger diameter pedicle screws (6.5 mm) at L5 and S1 level. During the same stage through anterior transperitoneal approach L5-S1 interbody fusion was done. At one-year follow-up after second-stage definitive surgery, patient remains symptom-free and fully active without any radiological evidence of reduction loss or implant failure

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Not AvailableEssential oils have applications in folk medicine, food preservation, and as feed additives. The essential oils of Lantana camara Linn. (Verbenaceae), Ageratum houstonianum Mill. (Asteraceae) and Eupatorium adenophorum Spreng. (Asteraceae) were analyzed by Gas chromatography - mass spectrometry (GCMS). In L. camara oil, of the total identified (83.91%) volatile constituents, five constituents [3,7,11 - trimethyl - 1,6,10 - dodecatriene (28.86%), β - caryophyllene (12.28%), zingiberene (7.63%), γ - curcumene (7.50%) and α - humulene (3.99%)] represented the major ones. In A. houstonianum oil, among the total identified volatile constituents (94.51%), three [precocene - II (52.64%), precocene - I (22.45%) and β - caryophyllene (9.66%)] represented the major ones. In E. adenophorum oil, of the total identified volatile constituents (84.95%), six [1 - napthalenol (17.50%), α - bisabolol (9.53%), bornyl acetate (8.98%), β - bisabolene (6.16%), germacrene - D (5.74%) and α - phellandrene (3.85%)] represented the major ones. The antibacterial activity expressed as Minimum Bactericidal Concentration (MBC) (μg/mL) was determined by the broth dilution method. The essential oil of E. adenophorum had antibacterial activity against Arthrobacter protophormiae, Escherichia coli, Micrococcus luteus, Rhodococcus rhodochrous, and Staphylococcus aureus with MBC values of 200, 100, 100, 12.5, and 200, respectively. The essential oil of A. houstonianum showed antibacterial activity against M. luteus and R. rhodochrous with MBC of 100 and 12.5, but not against A. protophormiae, E. coli, and S. aureus. The essential oil of L. camara showed antibacterial activity against A. protophormiae, M. luteus, R. rhodochrous and S. aureus with MBC of 50, 25, 12.5, and 200, respectively, but not against E. coli. MBC was lowest for R. rhodochrous for all the three essential oils.Not Availabl

Vasculitis and vasculopathy in Lupus Nephritis: Clinical variability, outcome, and new insight into treatment

More than 50% of patients with systemic lupus erythematosus (SLE) have renal involvement at presentation or during their illness. Lupus nephritis (LN) encompasses several patterns of renal disease, including glomerular, tubulointerstitial, and vascular pathologies. The presence and significance of renal vascular lesions (VLs) are often overlooked. VLs in LN are not rare with an incidence of 10%–40% on renal biopsies from various studies and their presence is often labeled as poor prognostic markers. The current treatment protocol for LN is mainly based on the glomerular pathology, and no guidelines/consensus exists for treatment of LN with VLs. We describe the clinical presentation, course, response to therapy, and outcomes in five patients with SLE with histological evidence of renal VLs

Comparison of headspace analysis of volatile constituents with GC–MS analysis of hydrodistilled and supercritical fluid extracted oil of Capillipedium parviflorum

Volatile constituents of the aerial parts of Capillipedium parviflorum were studied by two different extraction procedures, hydrodistillation (HD), supercritical CO2 extraction (Sc-CO2) and compared with headspace analysis (HS). Sc- CO2 extraction was carried out using nine differential optimization extractions (DOX) at different temperatures (°C) and pressures (MPa), i.e. 35/9, 60/9, 85/9, 35/17, 60/17, 85/17, 35/25, 60/25 and 85/25, to assess the influence on the yield and composition of volatile constituents. In DOX experiments, oil yields varied between 0.01–0.18% and maximum yield (0.18%) was obtained using temperatures and pressures 35/17 and 85/25. The oil is characterized by distinctive presence of very high content of non-terpenes (90.7%) identified in HD oil, 84.0% in Sc-CO2 oil and 92.5% in HS analysis. Monoterpenes were represented in low concentrations in HD oil and were totally absent in Sc- CO2 as well as in HS analysis. Very little variability was observed in the oxygenated monoterpenes in both Sc-CO2 and HD oil representing a low percentage of constituents. Sesquiterpene hydrocarbons were represented between 1.5% and 3.1% in Sc-CO2 extraction, which was higher in comparison with HD and HS techniques. Oxygenated sesquiterpenes were represented in higher percentage in Sc-CO2 than in HD oil and HS analysis. Variability among the major constituents of 4-nonanone, 4-nonanol, 4-undecanone and 4-undecanol was observed in Sc-CO2 extraction carried out under varied temperatures and pressures. Their percentage also varied in HD and HS analysis. 4-Nonanone (2.5%, 60/9 in Sc-CO2; 6.4% in HD and 4.3% in HS), 4-nonanol (21.5% in Sc-CO2, 31.7% in HD and 29.5% in HS), 4-undecanone (33.3%, 85/9 in Sc-CO2; 35.3% in HD and 44.5% in HS) and 4-undecanol (16.5%, 84/17, 60/25 in Sc-CO2; 14.6% in HD and 10.3% in HS) dominated the volatile constituents