TRPV4 stimulates colonic afferents through mucosal release of ATP and glutamate.

Background And Purpose: Abdominal pain is a leading cause of morbidity for people living with gastrointestinal disease. Whereas the transient receptor potential vanilloid 4 (TRPV4) ion channel has been implicated in the pathogenesis of abdominal pain, the relative paucity of TRPV4 expression in colon-projecting sensory neurons suggests that non-neuronal cells may contribute to TRPV4-mediated nociceptor stimulation.

Experimental Approach: Changes in murine colonic afferent activity were examined using ex vivo electrophysiology in tissues with the gut mucosa present or removed.

GPR35 agonists inhibit TRPA1-mediated colonic nociception through suppression of substance P release.

The development of nonopioid analgesics for the treatment of abdominal pain is a pressing clinical problem. To address this, we examined the expression of Gi/o-coupled receptors, which typically inhibit nociceptor activation, in colonic sensory neurons. This led to the identification of the orphan receptor GPR35 as a visceral analgesic drug target because of its marked coexpression with transient receptor potential ankyrin 1 (TRPA1), a mediator of noxious mechanotransduction in the bowel.

Digging deeper into pain: an ethological behavior assay correlating well-being in mice with human pain experience.

The pressing need for safer, more efficacious analgesics is felt worldwide. Preclinical tests in animal models of painful conditions represent one of the earliest checkpoints novel therapeutics must negotiate before consideration for human use. Traditionally, the pain status of laboratory animals has been inferred from evoked nociceptive assays that measure their responses to noxious stimuli.

Genetics and nutrition impacts on herd productivity in the Northern Australian beef cattle production cycle.

Genetics and nutrition drive herd productivity due to significant impacts on all components of the beef cattle production cycle. In northern Australia, the beef production system is largely extensive and relies heavily on tropical cattle grazing low quality, phosphorus-deficient pastures with seasonal variations in nutritive value. The existing feedlots are predominantly grain-based; providing high-energy rations, faster turn-off and finishing of backgrounded cattle to meet market specifications.

Declaring Racism a Public Health Crisis in the United States: Cure, Poison, or Both?

Declaring racism a public health crisis has the potential to shepherd meaningful anti-racism policy forward and bridge long standing divisions between policy-makers, community organizers, healers, and public health practitioners. At their best, the declarations are a first step to address long standing inaction in the face of need. At their worst, the declarations poison or sedate grassroots momentum toward anti-racism structural change by delivering politicians unearned publicity and slowing progress on health equity.

A framework for operationalizing risk: A practical approach to patient safety.

The importance of patient safety has grown tremendously; however, there are insufficient resources dedicated to its practical application. We provide an overview of the framework for addressing patient safety within the Johns Hopkins Health System, which approaches patient safety in the context of risk at the patient, provider, unit, and system levels. We present practical examples of how this approach is applied and highlight the resources needed as well as describe how it fits within the broader quality management infrastructure in the health system on its journey toward high reliability.

Latent risk assessment tool for health care leaders.

Efforts to improve quality of care and patient safety have concentrated on provider practice and frontline care processes. Little attention has focused on understanding the role that leadership decisions play in creating risk within a health care system. The framework and tool described in this article builds on Reason's construct of latent organizational failure, by assessing the latent risks of leadership decisions, and identifying appropriate mitigation strategies before the implementation of a change.

Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action.

Nurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error.

Reducing and Sustaining Duplicate Medical Record Creation by Usability Testing and System Redesign.

Objectives: Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training.

Methods: We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns.

Improving Health Care Quality and Patient Safety Through Peer-to-Peer Assessment: Demonstration Project in Two Academic Medical Centers.

Despite decades of investment in patient safety, unintentional patient harm remains a major challenge in the health care industry. Peer-to-peer assessment in the nuclear industry has been shown to reduce harm. The study team's goal was to pilot and assess the feasibility of this approach in health care.

Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study.

Background: Second victims are healthcare workers who experience emotional distress following patient adverse events. Studies indicate the need to develop organisational support programmes for these workers. The RISE (Resilience In Stressful Events) programme was developed at the Johns Hopkins Hospital to provide this support.

A Model for the Departmental Quality Management Infrastructure Within an Academic Health System.

As quality improvement and patient safety come to play a larger role in health care, academic medical centers and health systems are poised to take a leadership role in addressing these issues. Academic medical centers can leverage their large integrated footprint and have the ability to innovate in this field. However, a robust quality management infrastructure is needed to support these efforts.

Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools.

Objectives: Our understanding of care transitions from hospital to home is incomplete. Malpractice claims are an important and underused data source to understand such transitions. We used malpractice claims data to (1) evaluate safety risks during care transitions and (2) help develop care transitions planning tools and pilot test their ability to evaluate care transitions from the hospital to home.

Associations between safety culture and employee engagement over time: a retrospective analysis.

With the growth of the patient safety movement and development of methods to measure workforce health and success have come multiple modes of assessing healthcare worker opinions and attitudes about work and the workplace. Safety culture, a group-level measure of patient safety-related norms and behaviours, has been proposed to influence a variety of patient safety outcomes. Employee engagement, conceptualised as a positive, work-related mindset including feelings of vigour, dedication and absorption in one's work, has also demonstrated an association with a number of important worker outcomes in healthcare.

The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice.

Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.

The Midwifery Legacies Project: history, progress, and future directions.

The Midwifery Legacies Project, formerly known as the OnGoing Group, was founded as an annual greeting card outreach aimed at maintaining contact with midwives as they approached retirement and beyond. In 2009, the importance of documenting personal and professional stories of midwives arose out of a bequest by a midwife who was relatively unknown outside of the community she served. The result has been the evolution of a robust collection of stories, which are known as the 20th Century Midwife Story Collection.

The power of involving house staff in quality improvement: an interdisciplinary house staff-driven vaccination initiative.

Immunization for influenza and pneumococcal pneumonia were incorporated into The Joint Commission "global immunization" core measure January 1, 2012. The authors' hospital chose to adhere strictly to guidelines to avoid overvaccination. An immunization order set was created to aid appropriate ordering practices.

Home birth in North America: attitudes and practice of US certified nurse-midwives and Canadian registered midwives.

Introduction: Scope of practice, competencies, and philosophy of maternity practice are similar among midwives in the United States and Canada. However, there are marked differences in intrapartum practice sites between registered midwives (RMs) and certified nurse-midwives (CNMs).

Methods: This study linked data from 2 national surveys: 1) a 2007 survey of CNM members of the American College of Nurse-Midwives (n = 1893); and 2) the Canadian Birth Place Study of maternity providers, including RM members of the Canadian Association of Midwives (n = 451) to compare the demographics, practice experience, and attitudes to home birth between these 2 types of North American midwives.

A class of temporal boundaries derived by quantifying the sense of separation.

The perception of moment-to-moment environmental flux as being composed of meaningful events requires that memory processes coordinate with cues that signify beginnings and endings. We have constructed a technique that allows this coordination to be monitored indirectly. This technique works by embedding a sequential priming task into the event under study.