Stakeholders\u27 Perceptions of a Hospital Based Emergency Medicine Education & Training Program: A System Change

Background: Emergency Medicine (EM) is a new and developing specialty around the world. In India, one model for capacity building has been the development of partnerships between US academic institutions and private healthcare institutions for implementing post-graduate education and training in EM. Initiated in 2007, programs have grown both in number and scope and have continued to attract new students and partner institutions. This study was undertaken to better understand the impact of EM training programs on hospital systems. Methods: A mixed-methods evaluation was undertaken at 5 program sites across India in the summer of 2016. Two researchers conducted onsite semi-structured interviews with key program stakeholders. Participants included hospital administrators, program directors, hospital consultants, and ancillary staff at each hospital. Interviews were recorded, transcribed and then analyzed using a rapid assessment process. Participants also completed a brief survey. Written surveys were analyzed with univariate analysis. Results: A total of 109 stakeholders were interviewed. Positive impacts were reported among all stakeholders, particularly among administrators, consultants, ancillary staff, and supervising physicians in the ED. 80% of hospital administrators and 90% of direct ED supervisors report improved quality of care particularly among critically ill patients. Some respondents, including 89% of administrators, attributed increased patient volumes at least in part due to the educational program. Of respondents, non-ED consultants were less likely to report improvement in quality during off-service rotations, but 92% reported improved patient care in the hospital related to the program. Positive impacts extended beyond the hospital with many examples of community outreach, layperson education, and improved hospital reputation. Discussion: Evaluation of a changing system of emergency care has proven challenging to study. These data reflect substantial impacts to a hospital and the surrounding system after development of an EM training program, extending beyond the hospital itself to community outreach programs and a wide variety of education and training programs. Further investigation may prove helpful in quantifying the reported improvement in quality and scope of impact

Women and gender transforming psychology, 2nd ed./ Yoder

xvii, 413 hal.: ill.; 23 cm

Are television commercials still achievement scripts for women?

Content analyses of television advertising document the ubiquity of traditional images of women, yet few studies have explored their impact. One noteworthy exception is the experiment by Geis, Brown, Jennings, and Porter (1984). These researchers found that the achievement aspirations of controls and women exposed to traditional images were lower than those of both women who viewed nontraditional replicas and men, leading to the conclusion that women\u27s aspirations were muted by sexist advertising. An updated extension and modification of their study with 185 college women and 96 men did not find an interaction between gender and ad exposure, suggesting some changes over time in women\u27s aspirations, as well as in the content and impact of commercials. Although women\u27s achievement scripts now appear more similar to men\u27s, as well as more resistant to sexist exposure, there are signs in the present data and related research that women\u27s aspirations are not fully impervious to sexism in the media. © 2008 Division 35, American Psychological Association

ntPET: A New Application of PET Imaging for Characterizing the Kinetics of Endogenous Neurotransmitter Release

We present a new application of positron emission tomography (“ntPET” or “neurotransmitter PET”) designed to recover temporal patterns of neurotransmitter release from dynamic data. Our approach employs an enhanced tracer kinetic model that describes uptake of a labeled dopamine D2/D3 receptor ligand in the presence of a time-varying rise and fall in endogenous dopamine. Data must be acquired during both baseline and stimulus (transient dopamine release) conditions. Data from a reference region in both conditions are used as an input function, which alleviates the need for any arterial blood sampling. We use simulation studies to demonstrate the ability of the method to recover the temporal characteristics of an increase in dopamine concentration that might be expected following a drug treatment. The accuracy and precision of the method—as well as its potential for false-positive responses due to noise or changes in blood flow—were examined. Finally, we applied the ntPET method to small-animal imaging data in order to produce the first noninvasive assay of the time-varying release of dopamine in the rat striatum following alcohol

Outcomes in the physiologically most severe congenital diaphragmatic hernia (CDH) patients: Whom should we treat?

PURPOSE: Centers that care for newborns with Congenital Diaphragmatic Hernia (CDH) may impose selection criteria for offering or limiting aggressive support in those patients most severely affected. The purpose of this study was to analyze outcomes in newborns with highly severe CDH uniformly treated for survival. METHODS: We reviewed 172 consecutive inborn patients without associated lethal anomalies treated at a single institution with a dedicated CDH program. Survival, respiratory outcome, and time to discharge in the most severe 10% (or fewer) of patients based on the physiologic measures of 5-minute Apgar, CDH Study Group (CDHSG) predicted survival, need for ECMO in the first 6 hours, and need for ECMO in the first 3 hours of life were studied. We also identified patients with best PaCO2 greater than 100 and best pH less than 7.0. A multivariate model (AUC-0.92) predicting mortality was also used to define the most severe 10%. RESULTS: Of 172 consecutive inborn patients, 18 had a 5-minute Apgar of 3 or less, and 11 survived (61%), 10 had a 5-minute Apgar of 2 or less, and 6 survived (60%), and 6 had a 5-minute Apgar of 1 or less, and 4 survived (67%). Seventeen had a CDHSG predicted survival less than 25%, and 9 survived (53%). Thirteen of 172 required ECMO for rescue in the first 6 hours of life, and 9 survived (69%), including 7 in the first 3 hours, and 5 survived (71%). Despite focused resuscitation in the delivery room and high levels of ventilatory support, 22 patients had a best PCO2 greater than 100 and best pH less than 7.0 for 1 hour or longer. Twelve of these 22 survived to discharge (55%). Of 17 defined by multivariate predictive model as the most severe, 8 survived (47%) with zero of the 3 ECMO ineligible prematures surviving. Of the 16 (10%) most severe ECMO-eligible patients, 10 of 16 survived (63%). All survivors were discharged home on no ventilatory support greater than nasal cannula oxygen. CONCLUSION: In newborn CDH patients without lethal associated anomalies, accepted measures of physiologic severity failed to predict mortality. Survival met or exceeded 50% even in the most severe 10% as defined by these measures. These data support the practice of treating each patient for survival regardless of the physiologic severity in the first hours of life, and selection criteria for not offering ECMO should be re-evaluated where practiced