Teamwork in Rural Emergency Health Care: A Simulation-Based Cross-over Study of Co-located and Distributed Teams.

Introduction: Despite the increasing use of distributed healthcare teams, performance evaluation is largely lacking. This study examined rural emergency health care in Sweden to determine the effect of teams being either co-located or distributed with remote physicians accessible via telemedicine.

Method: In this crossover study, 17 three-person teams were video recorded during co-located and distributed simulated scenarios.

Emergency care via video consultation: interviews on patient experiences from rural community hospitals in northern Sweden.

Background: Delivering emergency care in rural areas can be challenging, but video consultation (VC) offers opportunities to make healthcare more accessible. The communication and relationship between professionals and patients have a significant impact on the patient's experience of safety and inclusion. Understanding the patient perspective is crucial to developing good quality healthcare, but little is known about patient experiences of emergency care via VC in a rural context.

Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams - an observational study with a randomized cross-over design.

Background: In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team - creating 'distributed teams'. Patient participation is a core competency for healthcare professionals.

Associations of smartphone usage patterns with sleep and mental health symptoms in a clinical cohort receiving virtual behavioral medicine care: a retrospective study.

Study Objectives: We sought to develop behavioral sleep measures from passively sensed human-smartphone interactions and retrospectively evaluate their associations with sleep disturbance, anxiety, and depressive symptoms in a large cohort of real-world patients receiving virtual behavioral medicine care.

Methods: Behavioral sleep measures from smartphone data were developed: daily longest period of smartphone inactivity (inferred sleep period [ISP]); 30-day expected period of inactivity (expected sleep period [ESP]); regularity of the daily ISP compared to the ESP (overlap percentage); and smartphone usage during inferred sleep (disruptions, wakefulness during sleep period). These measures were compared to symptoms of sleep disturbance, anxiety, and depression using linear mixed-effects modeling.

A framework for precision "dosing" of mental healthcare services: algorithm development and clinical pilot.

Background: One in five adults in the US experience mental illness and over half of these adults do not receive treatment. In addition to the access gap, few innovations have been reported for ensuring the right level of mental healthcare service is available at the right time for individual patients.

Methods: Historical observational clinical data was leveraged from a virtual healthcare system.

Behavioural observation tool for patient involvement and collaboration in emergency care teams (PIC-ET-tool).

Background: Patient participation is advocated in various healthcare settings. Instruments for assessment and feedback have been developed to strengthen clinician-patient interaction. In an emergency department context, such instruments are still missing.

Patient participation in tele-emergencies - experiences from healthcare professionals in northern rural Sweden.

Introduction: Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'.

Automated mass spectrometry multi-attribute method analyses for process development and characterization of mAbs.

More than 370 biotherapeutics drug products have been approved by regulatory agencies on the US and EU markets and this industry continues to expand. Process change and optimization is necessary to develop new effective biologics in a cost effective and productive way. Consequently, improvement of analytical techniques is required for better product characterization according to Quality by Design (QbD) approach recommended by regulatory agencies.

Excessive phospholipid peroxidation distinguishes ferroptosis from other cell death modes including pyroptosis.

Lipid peroxidation (LPO) drives ferroptosis execution. However, LPO has been shown to contribute also to other modes of regulated cell death (RCD). To clarify the role of LPO in different modes of RCD, we studied in a comprehensive approach the differential involvement of reactive oxygen species (ROS), phospholipid peroxidation products, and lipid ROS flux in the major prototype modes of RCD viz.

Dual mode standoff imaging spectroscopy documents the painting process of the Lamb of God in the by J. and H. Van Eyck.

The ongoing conservation treatment program of the by Hubert and Jan Van Eyck, one of the iconic paintings of the west, has revealed that the designs of the paintings were changed several times, first by the original artists, and then during later restorations. The central motif, The Lamb of God, representing Christ, plays an essential iconographic role, and its depiction is important. Because of the prevalence of lead white, it was not possible to visualize the Van Eycks' original underdrawing of the Lamb, their design changes, and the overpaint by later restorers with a single spectral imaging modality.

Patient participation in gastrointestinal endoscopy - From patients' perspectives.

Background: Patient participation is associated with satisfaction and improved health-related outcomes. In gastrointestinal endoscopy, patient participation is an underexplored area.

Objective: To gain understanding on patients' experiences, attitudes and preferences concerning patient participation in the endoscopy pathway.

Nlrp3 inflammasome activation and Gasdermin D-driven pyroptosis are immunopathogenic upon gastrointestinal norovirus infection.

Norovirus infection is the leading cause of food-borne gastroenteritis worldwide, being responsible for over 200,000 deaths annually. Studies with murine norovirus (MNV) showed that protective STAT1 signaling controls viral replication and pathogenesis, but the immune mechanisms that noroviruses exploit to induce pathology are elusive. Here, we show that gastrointestinal MNV infection leads to widespread IL-1β maturation in MNV-susceptible STAT1-deficient mice.

Nucleic Acid Induced Interferon and Inflammasome Responses in Regulating Host Defense to Gastrointestinal Viruses.

The gut bacterial and fungal communities residing in the gastrointestinal tract have undisputed far-reaching effects in regulating host health. In the meantime, however, metagenomic sequencing efforts are revealing enteric viruses as the most abundant dimension of the intestinal gut ecosystem, and the first gut virome-wide association studies showed that inflammatory bowel disease as well as type 1 diabetes could be linked to the presence or absence of particular viral inhabitants in the intestine. In line with the genetic component of these human diseases, mouse model studies demonstrated how beneficial functions of a resident virus can switch to detrimental inflammatory effects in a genetically predisposed host.

Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery.

Objective: To assess whether a multiphase, departmental quality improvement effort decreases opioid prescribing and increases multimodal analgesic use after cesarean delivery.

Methods: This is a prospective quality improvement study. In phase 1 of the protocol, discharge providers implemented counseling regarding expectations for pain, typical need for opioids, and importance of multimodal nonopioid analgesic use and used shared decision-making to determine the number of opioids prescribed.

Person-centered endoscopy safety checklist: Development, implementation, and evaluation.

Aim: To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a "checklist intervention".

Methods: The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions.

The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants.

Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries.

National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations.

Background: Quality improvement, value-based care delivery, and personalized patient care depend on robust clinical, financial, and demographic data streams of neurosurgical outcomes. The neurosurgical literature lacks a comprehensive review of large national databases.

Objective: To assess the strengths and limitations of various resources for outcomes research in neurosurgery.

Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin: A Systematic Review of Spinal Epidural Hematoma.

Venous thromboembolism remains a major source of morbidity and mortality in obstetrics with an incidence of 29.8/100,000 vaginal delivery hospitalizations; cesarean delivery confers a 4-fold increased risk of thromboembolism when compared with vaginal delivery. Revised national guidelines now stipulate that the majority of women delivering via cesarean and women at risk for ante- or postpartum venous thromboembolism receive mechanical or pharmacological thromboprophylaxis.

Large-Area Elemental Imaging Reveals Van Eyck's Original Paint Layers on the Ghent Altarpiece (1432), Rescoping Its Conservation Treatment.

A combination of large-scale and micro-scale elemental imaging, yielding elemental distribution maps obtained by, respectively non-invasive macroscopic X-ray fluorescence (MA-XRF) and by secondary electron microscopy/energy dispersive X-ray analysis (SEM-EDX) and synchrotron radiation-based micro-XRF (SR μ-XRF) imaging was employed to reorient and optimize the conservation strategy of van Eyck's renowned Ghent Altarpiece. By exploiting the penetrative properties of X-rays together with the elemental specificity offered by XRF, it was possible to visualize the original paint layers by van Eyck hidden below the overpainted surface and to simultaneously assess their condition. The distribution of the high-energy Pb-L and Hg-L emission lines revealed the exact location of hidden paint losses, while Fe-K maps demonstrated how and where these lacunae were filled-up using an iron-containing material.

Venous Thromboembolism in Patients Undergoing Craniotomy for Brain Tumors: A U.S. Nationwide Analysis.

 Patients who undergo craniotomy for brain tumor have an increased risk of developing venous thromboembolism (VTE). Using the National Surgical Quality Improvement Program (NSQIP) registry, patients undergoing craniotomy for brain tumor from 2006 and 2014 were analyzed to identify risk factors for postoperative VTE.  The study population, identified by Current Procedural Terminology codes, included all NSQIP-reported patients who underwent a craniotomy for brain tumor resection.

General Strategies in Inflammasome Biology.

The complementary actions of the innate and adaptive immune systems often provide effective host defense against microbial pathogens and harmful environmental agents. Germline-encoded pattern recognition receptors (PRRs) endow the innate immune system with the ability to detect and mount a rapid response against a given threat. Members of several intracellular PRR families, including the nucleotide-binding domain and leucine-rich repeat containing receptors (NLRs), the AIM2-like receptors (ALRs), and the tripartite motif-containing (TRIM) protein Pyrin/TRIM20, nucleate the formation of inflammasomes.

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates.

Background: While medical criteria have been well established for each end-organ system, psychosocial listing criteria are less standardized. To address this limitation, we developed and tested a new assessment tool: the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT).

Methods: The SIPAT was developed from a comprehensive review of the literature on the psychosocial factors that impact transplant outcomes.

The impact of aging on long-term care in Europe and some potential policy responses.

The article examines recent data on the impact of increasing numbers of elderly people in Europe on expenditures for long-term care services. After reviewing recent and projected future costs of long-term care, the authors examine current national strategies for long-term care as well as potential policy options that could reduce future expenditures due to aging. Although long-term care expenditures in Europe will rise over the next several decades, countries can adopt a variety of strategies--many of them in social sectors outside the health system--to reduce or mitigate the overall effects of likely long-term care needs.

Improving international nurse training: an American-Italian case study.

Background: Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon. This, descriptive case study examines an early example of an American-Italian initiative of such training, in order to stimulate future international education of nurses.

Aim: To find out what factors have to be taken into account to improve training and what its potential effects are in exchange and also in the context of nurse migration.