Implementation of a Hospital-Wide Surge Plan to Reduce Emergency Department Length of Stay

Practice Problem: Suboptimal patient flow throughout the hospital has resulted in an increased length of stay (LOS) for emergency department patients and the potential for adverse events. PICOT: In admitted and discharged emergency room patients (P), how does a hospital-wide surge plan (I) compared to current throughput plan (C) affect the length of stay (O) within 8 weeks? Evidence: The literature evidence reviewed supported the implementation of a hospital-wide surge plan approach positively impacts the emergency room length of stay and patient outcomes. Intervention: The primary intervention for this project was the implementation of a hospital-wide surge policy. Targeted interventions focused on protocols for all areas to expedite processes to improve throughput and decrease the LOS for ED admitted and discharged patients. Outcome: While the post-data results did not have a statistically significant change in the ED length of stay (LOS) for admitted and discharged patients, the results nevertheless, demonstrated a significant clinical impact on hospital-wide throughput and clinical outcomes. Conclusion: Using a hospital-wide surge plan effectively improves hospital throughput and can lead to a decrease in ED length of stay for admitted and discharged patients. This project helped the leaders implement new processes to improve collaboration and throughput in the organization

The Use of Personal Response Transmitters in Extension Settings

Personal response transmitters (PRTs) facilitate effective education by encouraging audience participation and providing the educator with immediate indication of audience comprehension. Their use in an IPM training session in Missouri provided measures of teaching impact, audience knowledge base, and direction for discussion activities. Lessons learned from initial activities taught that things such as room setup, random distribution of the PRTs, question formation, technical assistance, and familiarity with possible responses were critical to their successful use

Discovery in IC10 of the farthest known symbiotic star

We report the discovery of the first known symbiotic star in IC10, a starburst galaxy belonging to the Local Group, at a distance of ~750kpc. The symbiotic star was identified during a survey of emission-line objects. It shines at V = 24.62+-0.04, V - R_C = 2.77+-0.05 and R_C - I_C = 2.39+-0.02 and suffers from E(B-V) = 0.85+-0.05 reddening. The spectrum of the cool component well matches that of solar neighborhood M8III giants. The observed emission lines belong to Balmer series, [SII], [NII] and [OIII]. They suggest a low electronic density, negligible optical depth effects and 35,000K < T_eff < 90,000K for the ionizing source. The spectrum of the new symbiotic star in IC10 is an almost perfect copy of that of Hen 2-147, a well known Galactic symbiotic star and Mira.Comment: 5 pages including 3 figures. MNRAS Letters accepted. Also available at http://pessoais.ov.ufrj.br/denise

IC10: the history of the nearest starburst galaxy through its Planetary Nebula and HII region populations

We report the results of spectroscopic observations, obtained with the Gemini North Multi-Object Spectrograph, of 9 planetary nebulae (PNe) and 15 \hii\ regions located in the 5.5\arcmin $\times$5.5\arcmin inner region of the nearby starburst galaxy IC10. Twelve new candidate PNe have been discovered during our pre-imaging phase. Nine of them have been spectroscopically confirmed. The direct availability of the electron temperature diagnostics in several nebulae allowed an accurate determination of the metallicity map of IC10 at two epochs: the present-time from \hii regions and the old/intermediate-age from PNe. We found a non-homogeneous distribution of metals at both epochs, but similar average abundances were found for the two populations. The derived age-metallicity relation shows a little global enrichment interpreted as the loss of metals by SN winds and to differential gas outflows. Finally, we analyzed the production of oxygen --through the third dredge-up-- in the chemical abundance patterns of the PN populations belonging to several dwarf irregular galaxies. We found that the third dredge-up of oxygen is a metallicity dependent phenomenon occurring mainly for 12+$\log$(O/H)$\leq$7.7 and substantially absent in IC10 PNe.Comment: 14 pages, 4 figures, 7 tables, accepted for publication by MNRA

On frames for Krein spaces

A definition of frames for Krein spaces is proposed, which extends the notion of ℐ-orthonormal bases of Krein spaces. A ℐ-frame for a Krein space (ℋ,[,]) is in particular a frame for ℋ in the Hilbert space sense. But it is also compatible with the indefinite inner product [ , ], meaning that it determines a pair of maximal uniformly ℐ-definite subspaces, an analogue to the maximal dual pair associated to a ℐ-orthonormal basis. Also, each ℐ-frame induces an indefinite reconstruction formula for the vectors in ℋ, which resembles the one given by a ℐ-orthonormal basis.Facultad de Ciencias Exacta

Photometric and Spectroscopic Studies of Massive Binaries in the Large Magellanic Cloud. I. Introduction and Orbits for Two Detached Systems: Evidence for a Mass Discrepancy?

The stellar mass-luminosity relation is poorly constrained by observations for high mass stars. We describe our program to find eclipsing massive binaries in the Magellanic Clouds using photometry of regions rich in massive stars, and our spectroscopic follow-up to obtain radial velocities and orbits. Our photometric campaign identified 48 early-type periodic variables, of which only 15 (31%) were found as part of the microlensing surveys. Spectroscopy is now complete for 17 of these systems, and in this paper we present analysis of the first two, LMC 172231 and ST2-28, simple detached systems of late-type O dwarfs of relatively modest masses. Our orbit analysis yields very precise masses (2%) and we use tomography to separate the components and determine effective temperatures by model fitting, necessary for determining accurate (0.05-0.07 dex) bolometric luminosities in combination with the light-curve analysis. Our approach allows more precise comparisons with evolutionary theory than previously possible. To our considerable surprise, we find a small, but significant, systematic discrepancy: all of the stars are slightly under-massive, by typically 11% (or over-luminous by 0.2 dex) compared to that predicted by the evolutionary models. We examine our approach for systematic problems, but find no satisfactory explanation. The discrepancy is in the same sense as the long-discussed and elusive discrepancy between the masses measured from stellar atmosphere analysis with the stellar evolutionary models, and might suggest that either increased rotation or convective overshooting is needed in the models. Additional systems will be discussed in future papers of this series, and will hopefully confirm or refute this trend.Comment: Accepted by the Astrophysical Journa

A kinematic study of planetary nebulae in the dwarf irregular galaxy IC10

We present positions, kinematics, and the planetary nebula luminosity function (PNLF) for 35 planetary nebulae (PNe) in the nearest starburst galaxy IC10 extending out to 3kpc from the galaxy's centre. We take advantage of the deep imaging and spectroscopic capabilities provided by the spectrograph FOCAS on the 8.2m Subaru telescope. The PN velocities were measured through the slitless-spectroscopy technique, which allows us to explore the kinematics of IC10 with high precision. Using these velocities, we conclude that there is a kinematic connection between the HI envelope located around IC10 and the galaxy's PN population. By assuming that the PNe in the central regions and in the outskirts have similar ages, our results put strong observational constraints on the past tidal interactions in the Local Group. This is so because by dating the PN central stars, we, therefore, infer the epoch of a major episode of star formation likely linked to the first encounter of the HI extended envelope with the galaxy. Our deep [OIII] images also allow us to use the PNLF to estimate a distance modulus of 24.1+/-0.25, which is in agreement with recent results in the literature based on other techniques.Comment: 10 pages, 9 figures, 2 tables. Accepted for publication in MNRA

Differential Phase Contrast Imaging of the Magnetostructural Transition and Phase Boundary Motion in Uniform and Gradient-doped FeRh-based Thin Films

No abstract available

Additive drug-specific and sex-specific risks associated with co-use of marijuana and tobacco during pregnancy: Evidence from 3 recent developmental cohorts (2003-2015).

BACKGROUND: Methodologic challenges related to the concomitant use (co-use) of substances and changes in policy and potency of marijuana contribute to ongoing uncertainty about risks to fetal neurodevelopment associated with prenatal marijuana use. In this study, we examined two biomarkers of fetal neurodevelopmental risk-birth weight and length of gestation-associated with prenatal marijuana use, independent of tobacco (TOB), alcohol (ALC), other drug use (OTH), and socioeconomic risk (SES), in a pooled sample (N = 1191) derived from 3 recent developmental cohorts (2003-2015) with state-of-the-art substance use measures. We examined differential associations by infant sex, and multiplicative effects associated with co-use of MJ and TOB. METHODS: Participants were mother-infant dyads with complete data on all study variables derived from Growing Up Healthy (n = 251), Behavior and Mood in Babies and Mothers (Cohorts 1 and 2; n = 315), and the Early Growth and Development Study (N = 625). We estimated direct effects on birth weight and length of gestation associated with MJ, TOB, and co-use (MJ x TOB), using linear regression analysis in the full sample, and in male (n = 654) and female (n = 537) infants, separately. RESULTS: Mean birth weight and length of gestation were 3277 g (SD = 543) and 37.8 weeks (SD = 2.0), respectively. Rates of prenatal use were as follows: any use, n = 748 (62.8%); MJ use, n = 273 (22.9%); TOB use, n = 608 (51.0%); co-use of MJ and TOB, n = 230 (19.3%); ALC use, n = 464 (39.0%); and OTH use n = 115 (9.7%.) For all infants, unique effects on birth weight were observed for any MJ use [B(SE) = -84.367(38.271), 95% C.I. -159.453 to -9.281, p = .028], any TOB use [B(SE) = -0.99.416(34.418), 95% C.I. -166.942 to -31.889, p = .004], and each cigarette/day in mean TOB use [B(SE) = -12.233(3.427), 95% C.I. -18.995 to -5.510, p \u3c .001]. Additional effects of co-use on birth weight, beyond these drug-specific effects, were not supported. In analyses stratified by sex, while TOB use was associated with lower birth weight in both sexes, MJ use during pregnancy was associated with lower birth weight of male infants [B(SE) = -153.1 (54.20); 95% C.I. -259.5 to -46.7, p = .005], but not female infants [B(SE) = 8.3(53.1), 95% C.I. -96.024 to 112.551, p = .876]. TOB, MJ, and their co-use were not associated with length of gestation. CONCLUSIONS: In this sample, intrauterine co-exposure to MJ and TOB was associated with an estimated 18% reduction in birth weight not attributable to earlier delivery, exposure to ALC or OTH drugs, nor to maternal SES. We found evidence for greater susceptibility of male fetuses to any prenatal MJ exposure. Examination of dose-dependence in relationships found in this study, using continuous measures of exposure, is an important next step. Finally, we underscore the need to consider (a) the potential moderating influence of fetal sex on exposure-related neurodevelopmental risks; and (b) the importance of quantifying expressions of risk through subtle alterations, rather than dichotomous outcomes