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Outcomes of Using an Electronic Anesthesia-Focused Intake Form
No full textIntroduction: Operating rooms contribute significantly to hospital expenses, making cost-effective and efficient pre-anesthesia testing (PAT) evaluation critical. With growing surgical volumes, an aging population, and increased complexity of medical conditions, it is essential to optimize resources while maintaining high-quality care. To streamline the PAT process an electronic patient engagement tool was implemented to collect comprehensive medical and anesthesia histories once a patient is scheduled for surgery. This information is used by the PAT clinicians to determine if a patient is optimized for surgery.
Identification of the problem: A lack of comprehensive patient information can impede the PAT evaluation, delay care, and decrease clinician productivity.
QI Question/Purpose of the Study: The purpose of the study is to evaluate whether the use of a patient-driven anesthesia-focused electronic health questionnaire increases clinician productivity with patient evaluation and optimization, compared to patients who do not complete the questionnaire. Additionally, the study will assess the impact of the questionnaire on timeliness of patient contact before and after implementation.
Methods: The intervention will be assessed by a retrospective analysis of productivity and case-cancellation dashboards. Data will be examined 40 weeks before and 40 weeks after the implementation of the electronic anesthesia-focused intake form.
Outcomes/Results: Implementing an electronic anesthesia-focused intake questionnaire is expected to enhance clinician productivity and improve the timeliness of patient contact. This initiative aims to expedite the initiation of the perioperative process. Data collection will begin in October 2024.
Discussion: The perioperative journey begins once the patient is scheduled for surgery. It is imperative to have comprehensive medical and anesthesia histories to ensure a positive outcome from the surgical procedure and anesthesia. Obtaining the information early will allow optimization of medical conditions and development of the anesthetic plan.
Conclusion: Initiating patient engagement early will enhance the perioperative process and lead to improved outcomes.
Implications for paranesthesia nurses and future research: The project will demonstrate the importance of the electronic anesthesia-focused intake form with early identification of medical conditions that may require early intervention or optimization prior to surgery and anesthesia. Future research should be considered to explore the patient’s experience with the electronic intake form to further enhance the perioperative process
Biological-Physical Interaction of Particle Distribution: The Turbulent Mixed-Layer Pump and Particle Sinking Explored Through Modeling and Observations
No full textThe process of transporting Particulate Organic Carbon (POC) to the deep ocean by gravitational sinking is crucial component of the biological carbon pump (BCP). However, observations in the mesopelagic zone show that a considerable portion of POC stock of small slow sinking particles (22 to 100 micrometer) cannot be explained by BCP alone and that an important contribution comes from turbulent mixing of the seasonal mixed-layer (ML) pump. Here, we implement a 1D Mellor-Yamada turbulent model based on seasonal surface wind stress and heat flux that combines particle sinking velocity with turbulent mixing dynamics to study changes in particle concentration with depth. The comparison between observations of vertical particle distributions of small and slow-sinking particles in the Atlantic Ocean near Bermuda and model results are promising and may explain the role that the mixed-layer pump plays in these particle distributions. The model allows us to evaluate the impact of wind and wave mixing as well as stratification on particle distribution and transport
Development of Hierarchically Porous Biocarbon Materials from Food Waste for High-Performance Supercapacitors
No full textThe rapid depletion of fossil resources, coupled with growing environmental concerns, underscores the urgent need for renewable materials in energy storage systems. This study presents the fabrication of highly porous biocarbon materials derived from food waste via hydrothermal carbonization (HTC) for use as high-performance electrode materials in supercapacitors. The engineered biocarbons are thoroughly characterized using advanced analytical techniques, including scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET) surface area analysis, thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS), Fourier-transform infrared (FTIR) spectroscopy, and Raman spectroscopy, to investigate their morphological, structural, and physicochemical properties. The electrochemical performance of the biocarbon electrodes is evaluated through cyclic voltammetry (CV), galvanostatic charge-discharge (GCD), and electrochemical impedance spectroscopy (EIS) to assess their charge storage capabilities. Furthermore, life cycle assessment (LCA) and techno-economic analysis (TEA) are conducted to evaluate the environmental sustainability and commercial feasibility of the developed biocarbon materials. This research highlights the significant potential of food waste-derived biocarbons as sustainable and cost-effective electrode materials for energy storage applications, contributing to both environmental sustainability and the advancement of clean energy technologies
32 - Nested Two Level Decomposition for Quantum Computing
Get PDFAbstract—We present a two-level decomposition strategy for solving the Vehicle Routing Problem (VRP) using the Quantum Approximate Optimization Algorithm (QAOA). A Problem-Level Decomposition (PLD) partitions a 9-node (72-qubit) VRP into smaller Traveling Salesman Problem (TSP) instances. Each TSP is then further simplified via Circuit-Level Decomposition (CLD), enabling execution on near-term quantum devices. Our approach achieves up to 90% reductions in circuit depth and qubit count. These results demonstrate the feasibility of solving VRPs previously too complex for quantum simulators and provide early evidence of potential quantum utility
EEG Spectral Analysis of Nighttime Sleep and Daytime MSLTs and Neurocognitive Evaluations in Subjects with co-morbid insomnia and OSA
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Chronic insomnia and obstructive sleep apnea commonly co-occur. Few studies have explored the neurophysiological and neurocognitive characteristics of COMISA, which could help guide improving treatment diagnostic tools and determining novel therapeutic targets. This study aims to explore the neurophysiological and neurocognitive characteristics of COMISA using electroencephalographic (EEG) spectral analysis and subjective and objective neurocognitive measurements.
Methods
Participants were from our community recruited OSA-insomnia-COMISA cohort with 206 included for our current analysis including 74 chronic insomniacs (CIs), 55 OSA patients and 77 COMISA patients. Standard polysomnography (PSG) and multiple sleep latency tests (MSLTs) were recorded and used to obtain relative EEG spectral power in each sleep stage during PSG and each session during MSLTs. A series of subjective and objective neurocognitive tests were conducted to evaluate executive function, attention, retrospective and prospective memory and meta-cognition.
Results
In PSG and MSLTs, COMISA patients showed combined EEG power characteristics of both CIs and OSA. Specifically, COMISA patients exhibited similar EEG spectral characteristics to CIs, with decreased delta and increased alpha and beta power in NREM sleep stages, and increased beta power in REM and MSLTs. Similar to the EEG spectral power profile of OSA, COMISA patients showed increased delta power in REM and MSLTs. Compared to OSA patients, COMISA patients exhibited worse subjectively measured attention and meta-cognition related to negative beliefs about uncontrollability and danger of worry (NEG), which were positively associated with ISI scores.
Conclusions
The EEG spectral power characteristics of COMISA patients in overnight PSG and daytime MSLT appear to be the manifestation of elements of both CIs and OSA. However, the neurocognitive features of COMISA patients in subjectively measured attention and NEG meta-cognition were primarily affected by chronic insomnia
Upper Airway Soot and Facial Burns Do Not Necessitate Intubation
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Identifying which patients are at risk for respiratory decompensation, whether from airway compromise or inhalation injury, is an important component of initial burn resuscitation. Findings that traditionally suggest the need for intubation include cutaneous burns to the face and neck, soot seen in the upper airway, and carbonaceous sputum. However, evidence suggests that a significant number of pre-burn center intubations are ultimately unnecessary. The purpose of this investigation was to determine if head and neck burns or sputum seen in the upper airways were correlated with the need for intubation.
Methods
This was a retrospective review of adults admitted to our center from 2019-2023 with concern for potential airway compromise or inhalation injury in the setting of a burn or smoke exposure. Patients were deemed as not requiring intubation if they were intubated less than 24 hours (including ICU admission for airway monitoring not ever requiring intubation). Patients were excluded if they died within the first 48 hours of admission. Data collected include burn/exposure mechanism, origin of intubation (in the field, at an outside hospital, or at our center), percent TBSA, presence of face and/or neck burn, soot seen in the upper airway, ventilator days, and grade of inhalation injury seen on bronchoscopy (if performed).
Results
107 patients met inclusion criteria. 60 patients (56.1%) had burns to the face and/or neck (only 3 patients had burns to the neck only without facial involvement). 44 patients (44.9%) had soot seen in the upper airway. A total of 47 patients (44%) remained intubated beyond 24 hours; 60 patients (56.1%) were admitted for airway monitoring, or were extubated in less than 24 hours. Multivariate analysis demonstrated that only percent TBSA was found to have any correlation with the need for intubation beyond 24 hours (ANOVA, P value 0.0022). Neither upper airway soot nor face/neck burns were associated with intubation beyond 24 hours, even when both of these findings were present. These findings were consistent in subgroup analysis of intubated patients only. In the 38 patients admitted to the ICU for airway monitoring, only 2 progressed to requiring intubation; these intubations required one attempt without any need for a surgical airway.
Conclusions
The presence of burns to the face and neck or soot in the upper airway were not correlated with a necessary intubation in our cohort. These signs are unlikely to represent any impending airway compromise, and should not necessitate endotracheal intubation in a patient without other traditional signs of respiratory failure.
Applicability of Research to Practice
To prevent unnecessary intubations, there must be an emphasis on the fact that endotracheal intubation is not required in every patient with upper airway soot or burns to the face and/or neck. Airway monitoring alone is a safe alternative. These points should be incorporated into pre-hospital and emergency medicine education.
Funding for the study
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The Role of Doulas in the Health Care Continuum for Pregnant People with Substance Use Disorder: Perspectives of Patients, Doulas, and Healthcare Providers
Get PDFObjectives/Goals: The goals of this research are to 1) determine the prevalence of perinatal doula services use in Virginia, with a focus on individuals with substance use disorders (SUD), 2) evaluate awareness of doulas among pregnant and postpartum people with SUD, and 3) assess provider knowledge and interaction with doulas for the care of this population. Methods/Study Population: Both quantitative and qualitative methods will be used to evaluate patient and healthcare provider knowledge regarding doula services and the patient–doula–healthcare provider relationship. Surveys and semi-structured interviews will be administered to doulas, pregnant and postpartum women, and healthcare providers in this mixed-methods approach. Information from the Centers for Medicare and Medicaid Services National Provider Identifier (NPI) Registry, and doula training programs will be utilized to recruit doulas for participation. Paper and online recruitment materials will be posted to engage pregnant and postpartum individuals. Healthcare provider recruitment will occur via the NPI Registry along with contacting physicians’ practices. SAS 9.4 and NVivo will be utilized for analysis. Results/Anticipated Results: This proposed research will be an initial assessment of the current state of doula services utilization, mothers’ knowledge of doulas and their purpose, and healthcare providers’ awareness of and partnership with doulas to provide optimal birthing and postpartum experiences to the pregnant and parenting population with and without SUD. Results from this study will be disseminated to community doulas, pregnant people and mothers with substance use disorders, and relevant healthcare providers to decrease barriers to doula care and advocate for consistent, systematic documentation of doula services in the medical record and in public health surveillance systems. Discussion/Significance of Impact: This study will be the first study to assess doula services utilization in Virginia, with a specific focus on pregnant and postpartum women with substance use disorders. This work will support advocacy for improved data capture and utilization regarding doula services in order to reduce barriers to care and improve perinatal outcomes
Computer Science for Middle School (CS4MS)
Get PDFThis session will discuss the project Computer Science for Middle School and the associated findings. This Virginia Department of Education funded project provides computer science Professional Development opportunities for in-service teachers, located in Southeastern Virginia, who instruct students in middle school grades 6- 8. Participating teachers learn to integrate computer science standards into core and elective content through online, asynchronous microcredentials and in-person Summer Workshops. The presentation will include project findings and next steps including teacher efficacy for implementing the computer science standards before and after completing the microcredentials and their students’ attitudes about computer science
Personalized Prediction of Tumor Recurrence With Image-Guided Physics-Informed Computational Model in High-Grade Gliomas
Get PDFHigh grade gliomas are infiltrating tumors characterized by their diffusive invasion and proliferative growth. Across and within patients heterogeneity of tumors makes it challenging to determine tumor spatial extent after surgical resection. Traditionally, tumor growth predictions after surgical resections rely on generalized models and population-based observations, which do not account for individual patient differences. To address this gap, we propose a personalized approach with image-guided computational model (digital twin) that incorporates physics-based modeling to predict tumor recurrence. Our digital twin involves an inverse modeling step, followed by a recurrence model that accounts for varying surgical effects. The physics-guided inverse model considers discrete loss, and estimates patient-specific diffusion (D) and proliferation (ρ) parameters from pre-operative magnetic resonance imaging (MRI) of 133 patients. The analysis is conducted using a publicly available dataset from The Cancer Imaging Archive (TCIA). The proposed model is personalized due to use of the patient-specific parameters gleaned from the real patient data to assess risk for both high-aggressive and low-aggressive tumor groups. The prognostic index for each patient reveals the interplay between tumor aggressiveness, surgical resection, and survival outcome. The results demonstrate that despite varying levels of surgical resections, patients with high-aggressive tumors have worse survival outcomes, with a median survival of 141-153 days due to rapid regrowth (0.10/day). In comparison, the low-aggressive group exhibits slower growth (0.06/day) and a median survival of 158-171 days. Furthermore, by integrating patient-specific diffusion and proliferation rates, the proposed method offers significant variability in tumor aggressiveness within high-grade gliomas
Information & Schedule Flyer
Get PDFInformation and schedule for Cardiovascular Research Symposium: Bridging Gaps and Advancing Care