An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project.

Unlabelled: Using plan-do-study-act (PDSA) cycles, this quality improvement (QI) project aimed to standardize an anesthetic protocol to optimize multimodal pain management for pediatric open inguinal hernia repair (OIHR).

Methods: PDSA cycle 1: in December 2017, we standardized the intraoperative OIHR anesthesia protocol by replacing transversus abdominis plane (TAP) or ilioinguinal-iliohypogastric (II) blocks and fentanyl with exclusively II blocks and fentanyl. PDSA cycle 2: in January 2019, we used an opioid sparing strategy, replacing II blocks and fentanyl with II blocks and dexmedetomidine.

Quantification of smooth pursuit dysfunction in multiple sclerosis.

Background: Smooth pursuit dysfunction is common in MS, but rarely quantified and may be missed on exam.

Methods: NeuroFitONE™ smooth pursuit performance measures were compared between MS (n = 20) and healthy control (n = 19) participants.

Results: Compared to controls, MS patients had lower proportion of smooth pursuit (0.

Perioperative anxiety in pediatric surgery: Induction room vs. operating room.

Background: Perioperative anxiety can have a profound and lasting effect on children and their parents, with up to 70 percent of children undergoing outpatient surgery experiencing significant physiologic and/or psychological manifestations of anxiety throughout the ambulatory surgical process. The physical healthcare environment itself can contribute to these feelings, substantially impacting the level of anxiety experienced by both the child and their parent.

Objective: This study sought to examine whether a difference exists between utilization of an induction room vs.

The pudendal nerve block for ambulatory urology: What's old is new again. A quality improvement project.

Introduction: Caudal epidural analgesia (CEA) is a common analgesic technique performed for pediatric penile surgeries; however, it has associated morbidity. The pudendal nerve block (PNB) has been described as an effective analgesic alternative to CEA.

Objective: In this quality improvement study, we aim to assess the efficacy of PNB as compared to CEA within our ambulatory surgery center (ASC).

Can You Catch It? Lessons Learned and Modification of ED Triage Symptom- and Travel-Screening Strategy.

Introduction: Efficient identification and isolation of patients with communicable diseases limits exposure to health care workers, other patients, and visitors. In August 2014, our team developed and implemented an algorithm to triage suspected cases of Ebola virus disease in a midwestern United States emergency department and outpatient clinics based on patient travel history and symptoms. Here, we present the lessons learned and modifications to update the tool.

In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative.

Background: Opioids have been a central component of routine adult and pediatric anesthesia for decades. However, the long-term effects of perioperative opioids are concerning. Recent studies show a 4.

Explainable machine-learning predictions for the prevention of hypoxaemia during surgery.

Although anaesthesiologists strive to avoid hypoxemia during surgery, reliably predicting future intraoperative hypoxemia is not currently possible. Here, we report the development and testing of a machine-learning-based system that, in real time during general anaesthesia, predicts the risk of hypoxemia and provides explanations of the risk factors. The system, which was trained on minute-by-minute data from the electronic medical records of over fifty thousand surgeries, improved the performance of anaesthesiologists when providing interpretable hypoxemia risks and contributing factors.

Molecular Pharmacodynamics-Guided Scheduling of Biologically Effective Doses: A Drug Development Paradigm Applied to MET Tyrosine Kinase Inhibitors.

The development of molecularly targeted agents has benefited from use of pharmacodynamic markers to identify "biologically effective doses" (BED) below MTDs, yet this knowledge remains underutilized in selecting dosage regimens and in comparing the effectiveness of targeted agents within a class. We sought to establish preclinical proof-of-concept for such pharmacodynamics-based BED regimens and effectiveness comparisons using MET kinase small-molecule inhibitors. Utilizing pharmacodynamic biomarker measurements of MET signaling (tumor pYMET/total MET ratio) in a phase 0-like preclinical setting, we developed optimal dosage regimens for several MET kinase inhibitors and compared their antitumor efficacy in a -amplified gastric cancer xenograft model (SNU-5).

Clinically Relevant Concentrations of Anticancer Drugs: A Guide for Nonclinical Studies.

Approved and marketed drugs are frequently studied in nonclinical models to evaluate the potential application to additional disease indications or to gain insight about molecular mechanisms of action. A survey of the literature reveals that nonclinical experimental designs ( or ) often include evaluation of drug concentrations or doses that are much higher than what can be achieved in patients (i.e.

Oculometric Assessment of Sensorimotor Impairment Associated with TBI.

Purpose: Diffuse tissue damage from impact or blast traumatic brain injury (TBI) degrades information processing throughout the brain, often resulting in impairments in sensorimotor function. We have developed an eye-movement assessment test, consisting of a simple, appropriately randomized, radial tracking task together with a broad set of oculometric measures that can be combined to yield a sensitive overall indicator of sensorimotor functional status. We show here that this multidimensional method can be used to detect and characterize sensorimotor deficits associated with TBI.

Redundancy reduction explains the expansion of visual direction space around the cardinal axes.

Motion direction discrimination in humans is worse for oblique directions than for the cardinal directions (the oblique effect). For some unknown reason, the human visual system makes systematic errors in the estimation of particular motion directions; a direction displacement near a cardinal axis appears larger than it really is whereas the same displacement near an oblique axis appears to be smaller. Although the perceptual effects are robust and are clearly measurable in smooth pursuit eye movements, all attempts to identify the neural underpinnings for the oblique effect have failed.

Oculometric assessment of dynamic visual processing.

Eye movements are the most frequent (∼3/s), shortest-latency (∼150-250 ms), and biomechanically simplest (one joint, no inertial complexities) voluntary motor behavior in primates, providing a model system to assess sensorimotor disturbances arising from trauma, fatigue, aging, or disease states. We have developed a 15-min behavioral tracking protocol consisting of randomized Rashbass (1961) step-ramp radial target motion to assess several aspects of the behavioral response to visual motion, including pursuit initiation, steady-state tracking, direction tuning, and speed tuning. We show how oculomotor data can be converted into direction- and speed-tuning oculometric functions, with large increases in efficiency over traditional button-press psychophysics.

G-loading and vibration effects on heart and respiration rates.

Background: Operational environments expose pilots and astronauts to sustained acceleration (G loading) and whole-body vibration, alone and in combination. Separately, the physiological effects of G loading and vibration have been well studied; both have effects similar to mild exercise. The few studies of combined G loading and vibration have not reported an interaction between these factors on physiological responses.

Onset of positional vertigo during exposure to combined G loading and chest-to-spine vibration.

Background: Aerospace environments commonly expose pilots to vibration and sustained acceleration, alone and in combination.

Case Reports: Of 16 experimental research participants, 3 reported symptoms of vertigo and signs of torsional nystagmus during or shortly following exposure to sustained chest-to-spine (+3.8 Gx) acceleration (G loading) and chest-to-spine (0.

Saccadic brightness decisions do not use a difference model.

Eye movements are the most frequent (∼3 per second), shortest-latency (∼150-250 ms), and biomechanically simplest (1 joint, no inertial complexities) voluntary motor behavior in primates, providing a model sensorimotor decision-making system. Current computational "difference" models of choice behavior utilize a single decision variable encoding the difference between two alternate signals, often implemented as a log-likelihood ratio. Alternatively, the oculomotor literature describes a "race" mechanism, in which two separate decision variables encoding the two alternate signals race against one another independently.

Rethinking human visual attention: spatial cueing effects and optimality of decisions by honeybees, monkeys and humans.

Visual attention is commonly studied by using visuo-spatial cues indicating probable locations of a target and assessing the effect of the validity of the cue on perceptual performance and its neural correlates. Here, we adapt a cueing task to measure spatial cueing effects on the decisions of honeybees and compare their behavior to that of humans and monkeys in a similarly structured two-alternative forced-choice perceptual task. Unlike the typical cueing paradigm in which the stimulus strength remains unchanged within a block of trials, for the monkey and human studies we randomized the contrast of the signal to simulate more real world conditions in which the organism is uncertain about the strength of the signal.

Diamide amino-imidazoles: a novel series of γ-secretase inhibitors for the treatment of Alzheimer's disease.

The synthesis and structure-activity relationship (SAR) of a novel series of di-substituted imidazoles, derived from modification of DAPT, are described. Subsequent optimization led to identification of a highly potent series of inhibitors that contain a β-amine in the imidazole side-chain resulting in a robust in vivo reduction of plasma and brain Aβ in guinea pigs. The therapeutic index between Aβ reductions and changes in B-cell populations were studied for compound 10 h.

An experience of virtual leadership development for human resource managers.

Problem: Strong leadership and management skills are crucial to finding solutions to the human resource crisis in health. Health professionals and human resource (HR) managers worldwide who are in charge of addressing HR challenges in health systems often lack formal education in leadership and management.

Approach: Management Sciences for Health (MSH) developed the Virtual Leadership Development Program (VLDP) with support from the United States Agency for International Development (USAID).

Effects of prior information and reward on oculomotor and perceptual choices.

Expectations about the environment influence motor behavior. In simple tasks, for example, prior knowledge about which stimulus event will likely occur or which response will likely be rewarded induces a tendency to take the favored action (i.e.