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Noise Reduction in the Operating Room
Full text linkBackground and Review of Literature: Excessive noise levels in the operating room (OR) have serious detrimental effects on both patients and providers, such as acoustic trauma, increased heart rate and blood pressure, angina, surgical site infection, fatigue, mental stress, and anxiety. There is currently no set standard endorsed for OR noise levels in the United States. Purpose: The purpose of the project was to reduce noise in the OR which has been shown to impair concentration and communication as well as to determine whether an educational intervention will reduce the average OR noise levels within a surgical case.
Methods: This quality improvement project included the use of a decibel reader for data collection purposes. It captured noise levels and stored them for evaluation of noise reduction post-educational intervention to quantify statistical significance. The intervention included an educational awareness campaign. An email was sent to all OR staff informing them of the negative effects associated with elevated noise levels backed by evidence-based research. Additionally, educational fliers were placed in common areas for staff to learn ways to reduce intraoperative noise. Implementation Plan/Procedure: Implementation of noise reduction education materials, along with a pre-intervention and post-education noise level measurement via smartphone application (app) was performed.
Implications/Conclusion: There are economical and accessible ways to measure noise levels in the OR, including the use of smartphone apps, that can aid in creating strategies for noise reduction. Implementation of noise reduction remedies such as education-based noise reduction programs, have shown to drastically decrease OR noise levels, postoperative complications, and staff distraction, and increase overall patient outcomes. This project supported the goal of decreasing noise levels in the OR
Impact of stain variation and color normalization for prognostic predictions in pathology
Full text linkIn recent years, deep neural networks (DNNs) have demonstrated remarkable performance in pathology applications, potentially even outperforming expert pathologists due to their ability to learn subtle features from large datasets. One complication in preparing digital pathology datasets for DNN tasks is the variation in tinctorial qualities. A common way to address this is to perform stain normalization on the images. In this study, we show that a well-trained DNN model trained on one batch of histological slides failed to generalize to another batch prepared at a different time from the same tissue blocks, even when stain normalization methods were applied. This study used sample data from a previously reported DNN that was able to identify patients with early-stage non-small cell lung cancer (NSCLC) whose tumors did and did not metastasize, with high accuracy, based on training and then testing of digital images from H&E stained primary tumor tissue sections processed at the same time. In this study, we obtained a new series of histologic slides from the adjacent recuts of the same tissue blocks processed in the same lab but at a different time. We found that the DNN trained on either batch of slides/images was unable to generalize and failed to predict progression in the other batch of slides/images (AU
Barcoded SARS-CoV-2 viruses define the impact of duration and route of exposure on the transmission bottleneck in a hamster model
Full text linkThe transmission bottleneck, defined as the number of viruses shed from one host to infect another, is an important determinant of the rate of virus evolution and the level of immunity required to protect against virus transmission. Despite its importance, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission bottleneck remains poorly characterized. We adapted a SARS-CoV-2 reverse genetics system to generate a pool of \u3e200 isogenic SARS-CoV-2 viruses harboring specific 6-nucleotide barcodes, infected donor hamsters with this pool, and exposed contact hamsters to paired infected donors, varying the duration and route of exposure. Following exposure, the nasal turbinates, trachea, and lungs were collected and the number of barcodes in each tissue was enumerated. We found that longer and more direct exposures increased the transmission bottleneck and that the upper airway is the primary source of transmitted virus in this model. Together, these findings highlight the utility of barcoded viruses as tools to rigorously study virus transmission
Intersection of race and rurality with health care-associated infections and subsequent outcomes
Full text linkIMPORTANCE: Health care-associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes.
OBJECTIVE: To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and subsequent outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted at 3 US urban and suburban hospitals. Participants were adults aged 18 years or older admitted for 48 hours or longer from January 1, 2017, to August 31, 2020. Statistical analysis was performed from November 2022 to April 2024.
EXPOSURE: Patient race and rurality status were defined as the combination of race (Black or White) and residence (urban or rural per patient zip code).
MAIN OUTCOMES AND MEASURES: HAI was defined as a positive culture from a urine, blood, or respiratory specimen obtained 48 hours or longer after admission. To determine the association of race and rurality with HAIs, multivariable generalized estimating equations models were used to account for clustering of admissions by patient. Among patients with HAI admissions, similar models examined post-HAI intensive care unit admission and in-hospital death.
RESULTS: Among 214 955 patients admitted to the hospital (median [IQR] age, 63 [51-73] years; 108 679 female patients [50.6%]; 72 490 Black patients [33.7%]; 142 465 White patients [66.3%]), recognized HAIs occurred during 6699 (3.1%). Compared with White urban patients, Black urban patients had a decreased risk of HAI (adjusted relative risk [aRR], 0.81; 95% CI, 0.75-0.87), White rural patients had an increased risk of HAI (aRR, 1.12; 95% CI, 1.05-1.20), and Black rural patients (aRR, 1.08; 95% CI, 0.81-1.44) had a similar risk of HAI. Among patients with HAI admissions, Black rural patients had an increased risk of intensive care unit admission (aRR, 1.92; 95% CI, 1.16-3.17) and in-hospital death (aRR, 1.78; 95% CI, 1.26-2.50). White rural and Black urban patients had outcomes similar to those of White urban patients.
CONCLUSIONS AND RELEVANCE: This cohort study of hospitalized adults identified inequities related to race and rurality in HAIs and adverse outcomes from HAIs. These findings suggest that factors such as structural racism and disinvestment in rural communities may be associated with individual HAI risk and post-HAI outcomes. Future work to further understand the reasons underpinning these disparities and methods to address structural factors through policy and process changes are critical to eliminate health inequities
Patient stratification by genetic risk in Alzheimer\u27s disease is only effective in the presence of phenotypic heterogeneity
Full text linkCase-only designs in longitudinal cohorts are a valuable resource for identifying disease-relevant genes, pathways, and novel targets influencing disease progression. This is particularly relevant in Alzheimer\u27s disease (AD), where longitudinal cohorts measure disease progression, defined by rate of cognitive decline. Few of the identified drug targets for AD have been clinically tractable, and phenotypic heterogeneity is an obstacle to both clinical research and basic science. In four cohorts (n = 7241), we performed genome-wide association studies (GWAS) and Mendelian randomization (MR) to discover novel targets associated with progression and assess causal relationships. We tested opportunities for patient stratification by deriving polygenic risk scores (PRS) for AD risk and severity and tested the value of these scores in predicting progression. Genome-wide association studies identified no loci associated with progression at genome-wide significance (α = 5×10-8); MR analyses provided no significant evidence of an association between cognitive decline in AD patients and protein levels in brain, cerebrospinal fluid (CSF), and plasma. Polygenic risk scores for AD risk did not reliably stratify fast from slow progressors; however, a deeper investigation found that APOE ε4 status predicts amyloid-β and tau positive versus negative patients (odds ratio for an additional APOE ε4 allele = 5.78 [95% confidence interval: 3.76-8.89], P\u3c0.001) when restricting to a subset of patients with available CSF biomarker data. These results provided no evidence for large-effect, common-variant loci involved in the rate of memory decline, suggesting that patient stratification based on common genetic risk factors for progression may have limited utility. Where clinically relevant biomarkers suggest diagnostic heterogeneity, there is evidence that a priori identified genetic risk factors may have value in patient stratification. Mendelian randomization was less tractable due to the lack of large-effect loci, and future analyses with increased samples sizes are needed to replicate and validate our results
Treatment patterns and outcomes in follicular lymphoma with POD24: An analysis from the LEO Consortium
Full text linkProgression of disease within 24 months of initial immunochemotherapy (POD24) is a negative prognostic factor for patients with follicular lymphoma (FL). There is no standard treatment after POD24. Assembling an academic-based cohort from the Lymphoma Epidemiology of Outcomes Consortium for Real World Evidence, we evaluated patterns of care and outcomes for 220 patients with FL with POD24 and retained FL histology. Therapy after POD24 was heterogeneous, with no treatment category accounting for \u3e25% of the total. Among patients initially treated with bendamustine-rituximab, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) was the predominant second-line choice (48%). Among patients initially treated with R-CHOP, aggressive salvage therapy was the predominant second-line choice (38%). Overall response rate to therapy after POD24 was 64% (95% confidence interval [CI], 56-70); complete response rate was 39% (95% CI, 32-46). The median event-free survival for therapy after POD24 was 9.8 months (95% CI, 7.3-12.1); 5-year overall survival (OS) was 71% (95% CI, 65-78). OS was inferior for patients aged \u3e70 years (hazard ratio [HR], 2.31; 95% CI, 1.27-4.20) and those with high-risk FL International Prognostic Index scores at diagnosis (HR, 2.10; 95% CI, 1.23-3.60). No treatment category stood out with more favorable results. Cause of death was predominantly lymphoma related. Patients with follicular histology at their POD24 event had a low cumulative incidence of transformation (1.1% at 5 years). Our study is among the largest cohorts describing contemporary patterns of care for patients with POD24, providing a focused data set useful for interpreting and designing prospective clinical trials in this population
A neuronal code for object representation and memory in the human amygdala and hippocampus
Full text linkHow the brain encodes, recognizes, and memorizes general visual objects is a fundamental question in neuroscience. Here, we investigated the neural processes underlying visual object perception and memory by recording from 3173 single neurons in the human amygdala and hippocampus across four experiments. We employed both passive-viewing and recognition memory tasks involving a diverse range of naturalistic object stimuli. Our findings reveal a region-based feature code for general objects, where neurons exhibit receptive fields in the high-level visual feature space. This code can be validated by independent new stimuli and replicated across all experiments, including fixation-based analyses with large natural scenes. This region code explains the long-standing visual category selectivity, preferentially enhances memory of encoded stimuli, predicts memory performance, encodes image memorability, and exhibits intricate interplay with memory contexts. Together, region-based feature coding provides an important mechanism for visual object processing in the human brain
iPSCs and iPSC-derived cells as a model of human genetic and epigenetic variation
Full text linkUnderstanding the interaction between genetic and epigenetic variation remains a challenge due to confounding environmental factors. We propose that human induced Pluripotent Stem Cells (iPSCs) are an excellent model to study the relationship between genetic and epigenetic variation while controlling for environmental factors. In this study, we have created a comprehensive resource of high-quality genomic, epigenomic, and transcriptomic data from iPSC lines and three iPSC-derived cell types (neural stem cell (NSC), motor neuron, monocyte) from three healthy donors. We find that epigenetic variation is most strongly associated with genetic variation at the iPSC stage, and that relationship weakens as epigenetic variation increases in differentiated cells. Additionally, cell type is a stronger source of epigenetic variation than genetic variation. Further, we elucidate a utility of studying epigenetic variation in iPSCs and their derivatives for identifying important loci for GWAS studies and the cell types in which they may be acting
Japanese Garden
Full text linkAnne Grabow is a post-doc OT student. She shared artwork that she creates when dealing with difficult days in her work as an OT.
Excerpt:
The place where I go to process the most difficult things I see and hear in practice is a Japanese garden. It is here that I come on my most difficulty days, in hopes that the healing presence of God and nature will do their work in cleansing my mind and heart before the next day, giving the difficulty of today back to the universe, and seeking to understand everything in its proper perspective.
A pdf discussing her thoughts and process for the painting can be found below in the supplemental files
She is a Garden
No full textJayme Oberman is a DPT student. She shared a poem.
Excerpt:
She is a garden with seeds for blood.They flow through her veins,Sprouting weeds where cuts should be.Her feet are roots, reaching for connection,entwining around the stem of affection