Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke.

Background: Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS.

Augmented Hip Proprioception Influences Mediolateral Foot Placement During Walking.

Hip abductor proprioception contributes to the control of mediolateral foot placement, which varies with step-by-step fluctuations in pelvis dynamics. Prior work has used hip abductor vibration as a sensory probe to investigate the link between vibration within a single step and subsequent foot placement. Here, we extended prior findings by applying time and location varying vibration in every step, seeking to predictably manipulate the continuous, step-by-step relationship between pelvis dynamics and foot placement.

Music to reduce stress in hospitalized patients.

Purpose: To determine the impact of music on the physiologic and psychological stress experienced by hospital inpatients.

Methods: This pilot study monitored vital signs; utilized pain, anxiety, and agitation rating scales; and gathered verbal feedback from 50 participating inpatients at the authors' healthcare facility as they listened to music via an audiovisual interactive patient engagement technology system.

Results: After listening to music for 30 minutes, patients reported significantly lower pain and anxiety.

Identifying Predictors of Airway Complications During Conscious Sedation Procedures.

Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea screening questionnaire used as a preprocedure evaluation tool to assess a patient's risk for obstructive sleep apnea. The purpose of this study was to determine whether risk factors for obstructive sleep apnea, using the STOP-Bang questionnaire, could predict procedural airway complications in 152 endoscopy patients following conscious sedation.

Continuous quadratus lumborum block as post-operative strategy for pain control in spinal fusion surgery.

Background And Aims: Lumbar spinal fusions have post-operative pain levels that can be difficult to treat. The objective of this study was to determine if using bilateral quadratus lumborum (QL) nerve block catheters for lumbar fusions changes the patient's post-operative recovery experience by reducing opioid consumption, thereby limiting potential risks and side effects and reducing recovery time.

Methods: There were a total of 52 surgical lumbar fusion patients in this single-center, retrospective cohort review.

Effects of Targeted Assistance and Perturbations on the Relationship Between Pelvis Motion and Step Width in People With Chronic Stroke.

During walking in neurologically-intact controls, larger mediolateral pelvis displacements or velocities away from the stance foot are accompanied by wider steps. This relationship contributes to gait stabilization, as modulating step width based on pelvis motion (hereby termed a "mechanically-appropriate" step width) reduces the risk of lateral losses of balance. The relationship between pelvis displacement and step width is often weakened among people with chronic stroke (PwCS) for steps with the paretic leg.

Altered active control of step width in response to mediolateral leg perturbations while walking.

During human walking, step width is predicted by mediolateral motion of the pelvis, a relationship that can be attributed to a combination of passive body dynamics and active sensorimotor control. The purpose of the present study was to investigate whether humans modulate the active control of step width in response to a novel mechanical environment. Participants were repeatedly exposed to a force-field that either assisted or perturbed the normal relationship between pelvis motion and step width, separated by washout periods to detect the presence of potential after-effects.

Measuring Efficiency of Semi-automated Brain Tumor Segmentation by Simulating User Interaction.

Traditionally, radiologists have crudely quantified tumor extent by measuring the longest and shortest dimension by dragging a cursor between opposite boundary points across a single image rather than full segmentation of the volumetric extent. For algorithmic-based volumetric segmentation, the degree of radiologist experiential involvement varies from confirming a fully automated segmentation, to making a single drag on an image to initiate semi-automated segmentation, to making multiple drags and clicks on multiple images during interactive segmentation. An experiment was designed to test an algorithm that allows various levels of interaction.

A Comparison of One- and Four-Open-Chart Access: No Change in Computerized Provider Order Entry Error Rates.

Objective: To assess changes in computerized provider order entry error rates among providers who with less than 24-hour notice were switched from four-chart access to one-chart-only access.

Methods: An interrupted time series analysis of emergency medicine providers, hospitalists, and maternal child health providers was performed with pairwise comparison of computerized provider order entry error rates within and between specialties. This retrospective snapshot consisted of four phases.

Maternal Sleepiness and Risk of Infant Drops in the Postpartum Period.

Background: An increase in infant drops on a postpartum unit prompted a quality improvement project to examine causes and formulate risk reduction strategies. Review of health records revealed that infant drops occurred more frequently when mothers fell asleep holding infants.

Methods: A prospective descriptive study was conducted with a convenience sample of 101 postpartum mother-infant dyads.

Designing and implementing an interdependent resilience culture.

Once an emergency occurs, companies find themselves competing for diminishing resources. Companies mired in confusion and debate often fail to obtain the resources necessary for a speedy recovery and fail to meet the expectations of their various interested parties. Unfortunately, it is during these emergencies that the firm is judged.

Implementation of an ECHO-Based Program to Provide Geriatric Specialty Care Consultation and Education to Remote Primary Care Teams.

Targeting specific practice changes and working directly with patient aligned care teams to change practice may be more productive than telehealth for improving outcomes in older veterans.

Interdisciplinary Transgender Veteran Care: Development of a Core Curriculum for VHA Providers.

The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners.

HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years.

Objectives: To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients.

Methods: A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years.

Teleconsultation and Training of VHA Providers on Transgender Care: Implementation of a Multisite Hub System.

Background: The Veterans Health Administration (VHA) is piloting a national program providing teleconsultation and training to clinicians to increase knowledge and comfort with treating transgender veterans and to expand clinical capacity. This program is based on Project ECHO and uses specialist expertise to train and educate front-line clinicians. Over time, the front-line clinicians increase knowledge and skills, enabling them to provide care locally and obviate need for patient travel.

The role of evidence and context for implementing a multimodal intervention to increase HIV testing.

Background: Increasing the use of routine preventive care such as HIV testing is important, yet implementation of such evidence-based clinical care is complex. The Promoting Action on Research Implementation in Health Services (PARiHS) model for implementation posits that implementation will be most successful when the evidence, context, and facilitation strategies are strong for the clinical practice. We evaluated the relative importance of perceived evidence, context, and facilitation of HIV testing during the implementation of a multimodal intervention in US Department of Veterans Affairs primary care clinics.

Early lessons learned in implementing a women's health educational and virtual consultation program in VA.

Background: Many Veterans Health Administration primary care providers (PCPs) have small female patient caseloads, making it challenging for them to build and maintain their women's health (WH) knowledge and skills. To address this issue, we implemented a longitudinal WH-focused educational and virtual consultation program using televideo conferencing.

Objective: To perform a formative evaluation of the program's development and implementation.

Implementing an HIV Rapid Testing-Linkage-to-Care Project Among Homeless Individuals in Los Angeles County: A Collaborative Effort Between Federal, County, and City Government.

Objectives. We developed and implemented an HIV rapid testing-linkage-to-care initiative between federal and local government. Methods.

New generation NMR bioreactor coupled with high-resolution NMR spectroscopy leads to novel discoveries in Moorella thermoacetica metabolic profiles.

An in situ nuclear magnetic resonance (NMR) bioreactor was developed and employed to monitor microbial metabolism under batch growth conditions in real time. We selected Moorella thermoacetica ATCC 49707 as a test case. M.

HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.

Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT).

Magnetic microreactors for efficient and reliable magnetic nanoparticle surface functionalization.

Microreactors have attracted wide attention in the nano- and biotechnology fields because they offer many advantages over standard liquid phase reactions. We report the development of a magnetic microreactor for reliable, fast and efficient surface functionalization of superparamagnetic iron oxide nanoparticles (SPIONs). A comprehensive study of the development process in terms of setup, loading capacity and efficiency is described.

A five-year self-sustainability analysis of nurse-administered HIV rapid testing in Veterans Affairs primary care.

In 2008, nurse-administered HIV oral rapid testing (RT) was introduced at the Veterans Affairs Primary Care Clinic in Downtown Los Angeles. Analysis at five years revealed variable yet increasing rates of HIV RT at that facility despite the fact that no post-launch support was provided by the implementation team. Qualitative interviews among stakeholders conducted at five years revealed the pre-existing implementation practices endemic to this clinic that facilitated this unprecedented success (e.

Sustaining nurse-rapid HIV testing in the U.S. Department of Veterans Affairs: lessons learned from a comparative evaluation.

Routine HIV testing in primary care is now recommended in the United States. The U.S.

Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities.

Background: Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown.

Objective: To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support.

Design: Three arm, quasi-experimental implementation research study.

Mass spectra of methyl esters of brominated fatty acids and their presence in soft drinks and cocktail syrups.

Rationale: Brominated vegetable oil (BVO) is frequently used as a solubility transmitter in soft drinks. Being banned in Europe and Japan but permitted in the United States and Canada, there is a need for analytical methods suitable for use in food control. Brominated fatty acids in BVO are usually determined by gas chromatography (GC) after their conversion into the corresponding methyl esters.