Directional emission of white light via selective amplification of photon recycling and Bayesian optimization of multi-layer thin films.

Over the last decades, light-emitting diodes (LED) have replaced common light bulbs in almost every application, from flashlights in smartphones to automotive headlights. Illuminating nightly streets requires LEDs to emit a light spectrum that is perceived as pure white by the human eye. The power associated with such a white light spectrum is not only distributed over the contributing wavelengths but also over the angles of vision.

Applying Implementation Science in Surgical Infection Quality Improvement.

Medical knowledge is constantly growing at an exponential rate. Despite this growth, it is estimated to take 17 years for medical innovation to reach the bedside and improve clinical care. Implementation science is the scientific study of methods to facilitate the update of evidence-based practice and research into regular use and policy.

Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests, which are thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical, and critically ill patients.

Better understanding the utilization of damage control laparotomy: A multi-institutional quality improvement project.

Background: Rates of damage control laparotomy (DCL) vary widely and consensus on appropriate indications does not exist. The purposes of this multicenter quality improvement (QI) project were to decrease the use of DCL and to identify indications where consensus exists.

Methods: In 2016, six US Level I trauma centers performed a yearlong, QI project utilizing a single QI tool: audit and feedback.

Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions.

Peptic ulcer disease (PUD) affects four million people worldwide. Perforated peptic ulcer (PPU) occurs in less than 15% of cases but is associated with significant morbidity and mortality rates. Administration of antibiotics is standard treatment for gastrointestinal perforations, including PPU.

Effect of damage control laparotomy on major abdominal complications and lengths of stay: A propensity score matching and Bayesian analysis.

Background: In patients for whom surgical equipoise exists for damage control laparotomy (DCL) and definitive laparotomy (DEF), the effect of DCL and its associated resource utilization are unknown. We hypothesized that DEF would be associated with fewer abdominal complications and less resource utilization.

Methods: In 2016, six US Level I trauma centers performed a yearlong, prospective, quality improvement project with the primary aim to safely decrease the use of DCL.

Prevention of Surgical Infections: Building or Renovating a New Intensive Care Unit.

Background: Renovating or building a new intensive care unit (ICU) can be a challenging project. Planning the renovation or rebuild as a quality improvement project will help break down the process into manageable pieces with clear goals.

Methods: Literature was reviewed with regards to ICU design and renovation, with specific attention to patient quality improvement, process and structural change, healthcare systems engineering, emerging technology, and infection control.

Bedside dysphagia screens in patients with traumatic cervical injuries: An ideal tool for an under-recognized problem.

Background: We initiated a prospective interventional study using a nurse-driven bedside dysphagia screen (BDS) in patients with cervical spine injury (CI) to address three objectives: (1) determine the incidence of dysphagia, (2) determine the utility of the new BDS as a screening tool, and (3) compare patient outcomes, specifically dysphagia-related complications, in the study period with a retrospective cohort.

Methods: All patients with CI admitted to a Level I trauma center were enrolled in a prospective 12-month study (June 2016-June 2017) and then were compared with a previous 18-month cohort of similar patients. Our new protocol mandated that every patient underwent a BDS before oral intake.

Consequences of Implementing a "Better" Blood Culture System.

Background: Blood cultures (BCx) are the gold standard for diagnosing blood stream infections. However, contamination remains a challenge and can increase cost, hospital days, and unnecessary antibiotic use. National goals are to keep overall BCx contamination rates to ≤3%.

Level I Trauma Centers: More Is Not Necessarily Better.

The optimal number of level I trauma centers (L1TCs) in a region has not been elucidated. To begin addressing this, we compared mortalities for patients treated in counties or regions with 1 L1TC to those with >1 L1TC across Ohio. Ohio Trauma Registry data from 2010 to 2012 were analyzed.

Current Pneumonia Surveillance Methodology: Similar Underestimation in Trauma and Surgical Patients in the Intensive Care Unit.

Background: In 2013, the Centers for Disease Control and Prevention (CDC) developed new surveillance definitions for ventilator-associated events (VAE), leading to concerns that hospitals may be underreporting the true incidence of ventilator-associated pneumonias (VAPs). We sought to compare rates of clinically diagnosed VAP with CDC defined possible VAPs (PVAPs) in patients with a VAE in the surgical/trauma intensive care unit (STICU).

Hypothesis: Significant difference exists between rates of clinical VAP and PVAP in patients with at least one VAE.

Performance of a regional trauma network: A state-wide analysis.

Background: The Northern Ohio Trauma System (NOTS), established in 2010, is a collaborative regional trauma system composed of one level I and several lower-level trauma centers (TCs) across multiple hospital systems. Mortalities between counties in NOTS and other Ohio counties were compared to assess NOTS performance.

Methods: State trauma registry was analyzed for patients 15 years or older from 2006 to 2012.

Cytomegalovirus enteritis manifesting as recurrent bowel obstruction and jejunal perforation in patient with acquired immunodeficiency syndrome: rare report of survival and review of the literature.

Background: Cytomegalovirus (CMV) enteritis presenting with perforation in the setting of acquired immunodeficiency syndrome (AIDS) represents a particularly deadly combination.

Methods: Case report and review of the pertinent literature.

Case Report: The authors report a patient with AIDS and CMV enteritis presenting as recurrent small-bowel obstruction and leading to perforation of the jejunum with subsequent survival.

Validation of a screening tool for the early identification of sepsis.

Background: Sepsis is the leading cause of mortality in noncoronary intensive care units. Recent evidence based guidelines outline strategies for the management of sepsis and studies have shown that early implementation of these guidelines improves survival. We developed an extensive logic-based sepsis management protocol; however, we found that early recognition of sepsis was a major obstacle to protocol implementation.