How good are we at determining risk? Quantifying the accuracy of clinician determined risk for VTE prophylaxis

Objectives: Create and validate a simple tool for concurrent audits of risk stratification, compliance and documentation Evaluate accuracy of clinician risk stratification and prophylatic ordering practice compared with a standardized Caprini RAM across different assigned risk categories Provide recommendations for EPIC VTE Prophylaxis CDS Developmenthttps://jdc.jefferson.edu/patientsafetyposters/1050/thumbnail.jp

Quantifying Patient Reported and Documented Compliance with Adjuncts to Venous Thromboembolism Prophylaxis

Objectives: 1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures. 2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.https://jdc.jefferson.edu/patientsafetyposters/1042/thumbnail.jp

Facile and Scalable Preparation of Graphene Oxide-Based Magnetic Hybrids for Fast and Highly Efficient Removal of Organic Dyes

This study reports the facile preparation and the dye removal efficiency of nanohybrids composed of graphene oxide (GO) and Fe[subscript 3]O[subscript 4] nanoparticles with various geometrical structures. In comparison to previously reported GO/Fe[subscript 3]O[subscript 4] composites prepared through the one-pot, in situ deposition of Fe[subscript 3]O[subscript 4] nanoparticles, the GO/Fe[subscript 3]O[subscript 4] nanohybrids reported here were obtained by taking advantage of the physical affinities between sulfonated GO and Fe[subscript 3]O[subscript 4] nanoparticles, which allows tuning the dimensions and geometries of Fe3O4 nanoparticles in order to decrease their contact area with GO, while still maintaining the magnetic properties of the nanohybrids for easy separation and adsorbent recycling. Both the as-prepared and regenerated nanohybrids demonstrate a nearly 100% removal rate for methylene blue and an impressively high removal rate for Rhodamine B. This study provides new insights into the facile and controllable industrial scale fabrication of safe and highly efficient GO-based adsorbents for dye or other organic pollutants in a wide range of environmental-related applications

Slow dynamics near glass transitions in thin polymer films

The $\alpha$-process (segmental motion) of thin polystyrene films supported on glass substrate has been investigated in a wider frequency range from 10$^{-3}$ Hz to 10$^4$ Hz using dielectric relaxation spectroscopy and thermal expansion spectroscopy. The relaxation rate of the $\alpha$-process increases with decreasing film thickness at a given temperature above the glass transition. This increase in the relaxation rate with decreasing film thickness is much more enhanced near the glass transition temperature. The glass transition temperature determined as the temperature at which the relaxation time of the $\alpha$-process becomes a macroscopic time scale shows a distinct molecular weight dependence. It is also found that the Vogel temperature has the thickness dependence, i.e., the Vogel temperature decreases with decreasing film thickness. The expansion coefficient of the free volume $\alpha_f$ is extracted from the temperature dependence of the relaxation time within the free volume theory. The fragility index $m$ is also evaluated as a function of thickness. Both $\alpha_f$ and $m$ are found to decrease with decreasing film thickness.Comment: 9 pages, 7 figures, and 2 table

The Pathway to Low Outlier Status in Venous Thromboembolism Events: An Analysis of Pancreatic Surgery in ACS NSQIP

Introduction: Our institution’s hepatopancreaticobiliary service (HPBS) is a high-volume pancreatic surgery service, which has demonstrated consistently low rates of symptomatic venous thromboembolism (VTE) compared to similar institutions as reported by NSQIP. We sought to determine if the HPBS’s regimented multimodal VTE prophylaxis pathway plays a role in achieving consistently low VTE rates. Methods: We queried the ACS NSQIP Participant User File and our institution’s data from 2011-2016 for major pancreatic operations. We used Chi-squared analysis to compare the HPBS and national patient populations, and created a matched dataset based on preoperative patient factors. Univariate and multivariate analyses were performed on both the aggregate and matched data to determine independent risk factors for symptomatic VTE formation. Results: Among 36,435 NSQIP patients, 850 (2.3%) received surgery by the HPBS. VTE rates were significantly lower for the HPBS (2.0%) compared to the national cohort (3.5%) (p=0.018); this significance was seen in the matched cohort as well (p=0.040). Upon multivariate analysis, having an operation performed by the HPBS independently conferred lower odds of VTE formation in both the aggregate (OR=0.572, p=0.024) and matched (OR=0.530, p=0.041) cohorts. Discussion: The HPBS had statistically lower rates of symptomatic VTE compared to the national cohort as reported by NSQIP. We identified an independent protective effect of the HPBS on VTE formation, which we believe to be due, at least in part, to adherence to a high risk VTE prophylaxis pathway. This pathway could serve as a model for other institutions hoping to improve their VTE rates

Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63–3.21) and renal failure (RR, 2.52; 95% CI, 1.82–3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07–5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05–2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important

Normal aging in mice is associated with a global reduction in cortical spectral power and network-specific declines in functional connectivity

Normal aging is associated with a variety of neurologic changes including declines in cognition, memory, and motor activity. These declines correlate with neuronal changes in synaptic structure and function. Degradation of brain network activity and connectivity represents a likely mediator of age-related functional deterioration resulting from these neuronal changes. Human studies have demonstrated both general decreases in spontaneous cortical activity and disruption of cortical networks with aging. Current techniques used to study cerebral network activity are hampered either by limited spatial resolution (e.g. electroencephalography, EEG) or limited temporal resolution (e.g., functional magnetic resonance imaging, fMRI). Here we utilize mesoscale imaging of neuronal activity in Thy1-GCaMP6f mice to characterize neuronal network changes in aging with high spatial resolution across a wide frequency range. We show that while evoked activity is unchanged with aging, spontaneous neuronal activity decreases across a wide frequency range (0.01-4 Hz) involving all regions of the cortex. In contrast to this global reduction in cortical power, we found that aging is associated with functional connectivity (FC) deterioration of select networks including somatomotor, cingulate, and retrosplenial nodes. These changes are corroborated by reductions in homotopic FC and node degree within somatomotor and visual cortices. Finally, we found that whole-cortex delta power and delta band node degree correlate with exploratory activity in young but not aged animals. Together these data suggest that aging is associated with global declines in spontaneous cortical activity and focal deterioration of network connectivity, and that these reductions may be associated with age-related behavioral declines

Thermally driven spin injection from a ferromagnet into a non-magnetic metal

Creating, manipulating and detecting spin polarized carriers are the key elements of spin based electronics. Most practical devices use a perpendicular geometry in which the spin currents, describing the transport of spin angular momentum, are accompanied by charge currents. In recent years, new sources of pure spin currents, i.e., without charge currents, have been demonstrated and applied. In this paper, we demonstrate a conceptually new source of pure spin current driven by the flow of heat across a ferromagnetic/non-magnetic metal (FM/NM) interface. This spin current is generated because the Seebeck coefficient, which describes the generation of a voltage as a result of a temperature gradient, is spin dependent in a ferromagnet. For a detailed study of this new source of spins, it is measured in a non-local lateral geometry. We developed a 3D model that describes the heat, charge and spin transport in this geometry which allows us to quantify this process. We obtain a spin Seebeck coefficient for Permalloy of -3.8 microvolt/Kelvin demonstrating that thermally driven spin injection is a feasible alternative for electrical spin injection in, for example, spin transfer torque experiments