Streamlining the Postpartum Educational Process for Safe and Equitable Patient Care: A Quality Improvement Initiative

Abstract BACKGROUND: Postpartum discharge education is essential in the care of mothers, newborns, and their families as they transition from the hospital setting to home. The U.S Department of Health and Human Services has identified postpartum discharge education content as a public health priority to reduce physical and mood-related postpartum complications. Over half of all serious morbidity and mortality complications occur after a postpartum patient leaves the hospital. It is essential that hospitals utilize the best evidence-based practices to maximize the impact of patient education during maternity care in the hospital. LOCAL PROBLEM: Within the given microsystem there is a need to streamline and standardize the discharge process to ensure equity in the resources provided to patients to improve maternal and newborn health. METHODS: Using a two-phase Plan-Do-Study-Act model, a quality improvement project was developed to both streamline and standardize the current discharge process. INTERVENTION: Using data from a pre-intervention nursing staff survey, a new streamlined and standardized nursing process was developed. Intervention was studied using quantitative Likert style questions and qualitative free text survey questions. RESULTS: Before the implementation of standardization, 86% of nurses interviewed disagreed or strongly disagreed that it was easy to find appropriate discharge education, while after the intervention 0% of nurses disagreed or strongly disagreed with 87% of nurses agreeing or strongly agreeing that it was easy to find needed education material. Prior to the standardization and streamlining intervention, 82% of nurses expressed barriers, while after the intervention only 13% of nurses noted barriers in the discharge process. CONCLUSION: The quality improvement project resulted in better standardization and streamlining of the postpartum education process with more nurses finding the process more accessible to navigate. These changes can result in more productivity overall which will allow nurses to focus more on time spent with the patient during the education process. Standardization not only ensures equity but will allow nurses to become more familiar with the high-quality evidence-based materials they present to patients. Keywords: Discharge, education, discharge process, postpartum education, standardization, streamlin

Too Big to Fail in the Local Group

We compare the dynamical masses of dwarf galaxies in the Local Group (LG) to the predicted masses of halos in the ELVIS suite of $\Lambda$CDM simulations, a sample of 48 Galaxy-size hosts, 24 of which are in paired configuration similar to the LG. We enumerate unaccounted-for dense halos ($V_\mathrm{max} \gtrsim 25$ km s$^{-1}$) in these volumes that at some point in their histories were massive enough to have formed stars in the presence of an ionizing background ($V_\mathrm{peak} > 30$ km s$^{-1}$). Within 300 kpc of the Milky Way, the number of unaccounted-for massive halos ranges from 2 - 25 over our full sample. Moreover, this "too big to fail" count grows as we extend our comparison to the outer regions of the Local Group: within 1.2 Mpc of either giant we find that there are 12-40 unaccounted-for massive halos. This count excludes volumes within 300 kpc of both the MW and M31, and thus should be largely unaffected by any baryonically-induced environmental processes. According to abundance matching -- specifically abundance matching that reproduces the Local Group stellar mass function -- all of these missing massive systems should have been quite bright, with $M_\star > 10^6M_\odot$. Finally, we use the predicted density structure of outer LG dark matter halos together with observed dwarf galaxy masses to derive an $M_\star-V_\mathrm{max}$ relation for LG galaxies that are outside the virial regions of either giant. We find that there is no obvious trend in the relation over three orders of magnitude in stellar mass (a "common mass" relation), from $M_\star \sim 10^8 - 10^5 M_\odot$, in drastic conflict with the tight relation expected for halos that are unaffected by reionization. Solutions to the too big to fail problem that rely on ram pressure stripping, tidal effects, or statistical flukes appear less likely in the face of these results.Comment: 16 pages, 14 figures, 2 tables, submitted to MNRA

Sterile neutrino dark matter bounds from galaxies of the Local Group

We show that the canonical oscillation-based (non-resonant) production of sterile neutrino dark matter is inconsistent at $>99$% confidence with observations of galaxies in the Local Group. We set lower limits on the non-resonant sterile neutrino mass of $2.5$ keV (equivalent to $0.7$ keV thermal mass) using phase-space densities derived for dwarf satellite galaxies of the Milky Way, as well as limits of $8.8$ keV (equivalent to $1.8$ keV thermal mass) based on subhalo counts of $N$-body simulations of M 31 analogues. Combined with improved upper mass limits derived from significantly deeper X-ray data of M 31 with full consideration for background variations, we show that there remains little room for non-resonant production if sterile neutrinos are to explain $100$% of the dark matter abundance. Resonant and non-oscillation sterile neutrino production remain viable mechanisms for generating sufficient dark matter sterile neutrinos.Comment: 10 pages, 4 figures, 2 tables. Submitted to PR

Wetlands Evaluation and Management in Virginia

Complex biotic communities which have lately been recognized as being of vital importance to aquatic and upland ecosystems have evolved at Virginia\u27s land-water interface. Most obvious are the beaches and vast intertidal stands of halophytic (salt-tolerant) plants on the periphery of the Atlantic Ocean, Chesapeake Bay and their subordinate estuaries. Less obvious, but no less important, are nonvegetated intertidal flats and coastal freshwater marshes. Inland swamps and freshwater marshes complete the inventory; though more limited in extent than their coastal analog. Complex biotic communities which have lately been recognized as being of vital importance to aquatic and upland ecosystems have evolved at Virginia\u27s land-water interface. Most obvious are the beaches and vast intertidal stands of halophytic (salt-tolerant) plants on the periphery of the Atlantic Ocean, Chesapeake Bay and their subordinate estuaries. Less obvious, but no less important, are nonvegetated intertidal flats and coastal freshwater marshes. Inland swamps and freshwater marshes complete the inventory; though more limited in extent than their coastal analog

Software for optimization of SNP and PCR-RFLP genotyping to discriminate many genomes with the fewest assays

BACKGROUND: Microbial forensics is important in tracking the source of a pathogen, whether the disease is a naturally occurring outbreak or part of a criminal investigation. RESULTS: A method and SPR Opt (SNP and PCR-RFLP Optimization) software to perform a comprehensive, whole-genome analysis to forensically discriminate multiple sequences is presented. Tools for the optimization of forensic typing using Single Nucleotide Polymorphism (SNP) and PCR-Restriction Fragment Length Polymorphism (PCR-RFLP) analyses across multiple isolate sequences of a species are described. The PCR-RFLP analysis includes prediction and selection of optimal primers and restriction enzymes to enable maximum isolate discrimination based on sequence information. SPR Opt calculates all SNP or PCR-RFLP variations present in the sequences, groups them into haplotypes according to their co-segregation across those sequences, and performs combinatoric analyses to determine which sets of haplotypes provide maximal discrimination among all the input sequences. Those set combinations requiring that membership in the fewest haplotypes be queried (i.e. the fewest assays be performed) are found. These analyses highlight variable regions based on existing sequence data. These markers may be heterogeneous among unsequenced isolates as well, and thus may be useful for characterizing the relationships among unsequenced as well as sequenced isolates. The predictions are multi-locus. Analyses of mumps and SARS viruses are summarized. Phylogenetic trees created based on SNPs, PCR-RFLPs, and full genomes are compared for SARS virus, illustrating that purported phylogenies based only on SNP or PCR-RFLP variations do not match those based on multiple sequence alignment of the full genomes. CONCLUSION: This is the first software to optimize the selection of forensic markers to maximize information gained from the fewest assays, accepting whole or partial genome sequence data as input. As more sequence data becomes available for multiple strains and isolates of a species, automated, computational approaches such as those described here will be essential to make sense of large amounts of information, and to guide and optimize efforts in the laboratory. The software and source code for SPR Opt is publicly available and free for non-profit use at

Predicting the sensitivity and specificity of published real-time PCR assays

<p>Abstract</p> <p>Background</p> <p>In recent years real-time PCR has become a leading technique for nucleic acid detection and quantification. These assays have the potential to greatly enhance efficiency in the clinical laboratory. Choice of primer and probe sequences is critical for accurate diagnosis in the clinic, yet current primer/probe signature design strategies are limited, and signature evaluation methods are lacking.</p> <p>Methods</p> <p>We assessed the quality of a signature by predicting the number of true positive, false positive and false negative hits against all available public sequence data. We found real-time PCR signatures described in recent literature and used a BLAST search based approach to collect all hits to the primer-probe combinations that should be amplified by real-time PCR chemistry. We then compared our hits with the sequences in the NCBI taxonomy tree that the signature was designed to detect.</p> <p>Results</p> <p>We found that many published signatures have high specificity (almost no false positives) but low sensitivity (high false negative rate). Where high sensitivity is needed, we offer a revised methodology for signature design which may designate that multiple signatures are required to detect all sequenced strains. We use this methodology to produce new signatures that are predicted to have higher sensitivity and specificity.</p> <p>Conclusion</p> <p>We show that current methods for real-time PCR assay design have unacceptably low sensitivities for most clinical applications. Additionally, as new sequence data becomes available, old assays must be reassessed and redesigned. A standard protocol for both generating and assessing the quality of these assays is therefore of great value. Real-time PCR has the capacity to greatly improve clinical diagnostics. The improved assay design and evaluation methods presented herein will expedite adoption of this technique in the clinical lab.</p

Fear Learning Regulates Cortical Sensory Representations by Suppressing Habituation

Projections from auditory cortex to the amygdala are thought to contribute to the induction of auditory fear learning. In addition, fear conditioning has been found to enhance cortical responses to conditioned tones, suggesting that cortical plasticity contributes to fear learning. However, the functional role of auditory cortex in the retrieval of fear memories is unclear and how fear learning regulates cortical sensory representations is not well understood. To address these questions, we use acute optogenetic silencing and chronic two-photon calcium imaging in mouse auditory cortex during fear learning. Longitudinal imaging of neuronal ensemble activity reveals that discriminative fear learning modulates cortical sensory representations via the suppression of cortical habituation

Microscale Mechanics of Plug-and-Play In Vitro Cytoskeleton Networks

This chapter describes recent techniques that have been developed to reconstitute and characterize well-controlled, tunable networks of actin and microtubules outside of cells. It describes optical tweezers microrheology techniques to characterize the linear and nonlinear mechanics of these plug-and-play in vitro networks from the molecular-level to mesoscopic scales. It also details fluorescence microscopy and single-molecule tracking methods to determine macromolecular transport properties and stress propagation through cytoskeleton networks. Throughout the chapter the intriguing results that this body of work has revealed are highlighted—including how the macromolecular constituents of cytoskeleton networks map to their signature responses to stress or strain; and the elegant couplings between network structure, macromolecular mobility, and stress response that cytoskeleton networks exhibit