Flash mob research: a single-day, multicenter, resident-directed study of respiratory rate.
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ABSTRACT:
SUBMITTER: Semler MW
PROVIDER: S-EPMC3747725 | biostudies-other | 2013 Jun
REPOSITORIES: biostudies-other
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Project description:Healthy tissue-sparing effects of FLASH (≥40 Gy/s, ≥4-8 Gy/fraction) radiotherapy (RT) make it potentially useful for whole breast irradiation (WBI), since there is often a lot of normal tissue within the planning target volume (PTV). We investigated WBI plan quality and determined FLASH-dose for various machine settings using ultra-high dose rate (UHDR) proton transmission beams (TBs). While five-fraction WBI is commonplace, a potential FLASH-effect might facilitate shorter treatments, so hypothetical 2- and 1-fraction schedules were also analyzed. Using one tangential 250 MeV TB delivering 5 × 5.7 Gy, 2 × 9.74 Gy or 1 × 14.32 Gy, we evaluated: (1) spots with equal monitor units (MUs) in a uniform square grid with variable spacing; (2) spot MUs optimized with a minimum MU-threshold; and (3) splitting the optimized TB into two sub-beams: one delivering spots above an MU-threshold, i.e., at UHDRs; the other delivering the remaining spots necessary to improve plan quality. Scenarios 1-3 were planned for a test case, and scenario 3 was also planned for three other patients. Dose rates were calculated using the pencil beam scanning dose rate and the sliding-window dose rate. Various machine parameters were considered: minimum spot irradiation time (minST): 2 ms/1 ms/0.5 ms; maximum nozzle current (maxN): 200 nA/400 nA/800 nA; two gantry-current (GC) techniques: energy-layer and spot-based. For the test case (PTV = 819 cc) we found: (1) a 7 mm grid achieved the best balance between plan quality and FLASH-dose for equal-MU spots; (2) near the target boundary, lower-MU spots are necessary for homogeneity but decrease FLASH-dose; (3) the non-split beam achieved >95% FLASH for favorable (not clinically available) machine parameters (SB GC, low minST, high maxN), but <5% for clinically available settings (EB GC, minST = 2 ms, maxN = 200 nA); and (4) splitting gave better plan quality and higher FLASH-dose (~50%) for available settings. The clinical cases achieved ~50% (PTV = 1047 cc) or >95% (PTV = 477/677 cc) FLASH after splitting. A single UHDR-TB for WBI can achieve acceptable plan quality. Current machine parameters limit FLASH-dose, which can be partially overcome using beam-splitting. WBI FLASH-RT is technically feasible.
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Project description:PurposeIn this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs).MethodsAll patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU.ResultsAmong the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk.ConclusionsAdmission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients.
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Project description:Background and purpose - Length of hospital stay (LOS) following total hip arthroplasty (THA) has been markedly reduced. Recently, same-day THA (SD-THA) was introduced, and previous studies have indicated satisfactory safety. However, studies are heterogeneous and only a few report results on SD-THA when using a posterolateral surgical approach. Thus, our aim was to evaluate the feasibility of and complications after SD-THA when using a posterolateral approach. Patients and methods - Consecutive patients scheduled for SD-THA between October 2015 and June 2016 were included. Eligibility criteria for SD-THA were: primary THA, motivation for same-day procedure, age > 18 years, ASA I or II, and the presence of a support person who could remain with the patient for 24 hours after surgery. A posterolateral surgical approach was used. Data were collected retrospectively from hospital records and the Danish National Patient Registry. Outcome measures were: complications during admission, LOS, causes of prolonged admission, and prevalence and causes of readmission at 90 days' follow-up. Results - 102 of 116 (88%) patients scheduled for SD-THA were discharged on the day of surgery. The remaining 14 patients were discharged the following day. Primary causes of prolonged admission were: dizziness/nausea, pain, and wound seepage. 7 patients had an estimated blood loss above 400 mL, but all were discharged as planned. No major complications occurred during admission. At follow-up, 3 patients had been readmitted due to pneumonia, wound infection, and dislocation, respectively. Interpretation - The results indicate that SD-THA performed with a posterolateral approach is feasible and can be performed with a low complication rate in a selected group of patients.
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Project description:Background:Assessment of trainees' competency is challenging; the predictive power of traditional evaluations is debatable especially in regard to noncognitive traits. New assessments need to be sought to better understand affective areas like personality. Grit, defined as "perseverance and passion for long-term goals," can assess aspects of personality. Grit predicts educational attainment and burnout rates in other populations and is accurate with an informant report version. Self-assessments, while useful, have inherent limitations. Faculty's ability to accurately assess trainees' grit could prove helpful in identifying learner needs and avenues for further development. Objective:This study sought to determine the correlation between EM resident self-assessed and faculty-assessed Grit Scale (Grit-S) scores of that same resident. Methods:Subjects were PGY-1 to -4 EM residents and resident-selected faculty as part of a larger multicenter trial involving 10 EM residencies during 2017. The Grit-S Scale was administered to participating EM residents; an informant version was completed by their self-selected faculty. Correlation coefficients were computed to assess the relationship between residents' self-assessed and the residents' faculty-assessed Grit-S score. Results:A total of 281 of 303 residents completed the Grit-S, for a 93% response rate; 200 of 281 residents had at least one faculty-assessed Grit-S score. No correlation was found between residents' self-assessed and faculty-assessed Grit-S scores. There was a correlation between the two faculty-assessed Grit-S scores for the same resident. Conclusion:There was no correlation between resident and faculty-assessed Grit-S scores; additionally, faculty-assessed Grit-S scores of residents were higher. This corroborates the challenges faculty face at accurately assessing aspects of residents they supervise. While faculty and resident Grit-S scores did not show significant concordance, grit may still be a useful predictive personality trait that could help shape future training.
| S-EPMC6339547 | biostudies-literature
Project description:Flash Sintering (FS), a relatively new Field-Assisted Sintering Technique (FAST) for ceramic processing, was proposed for the first time in 2010 by Prof. Rishi Raj's group from the University of Colorado at Boulder. It quickly grabbed the attention of the scientific community and since then, the field has rapidly evolved, constituting a true milestone in materials processing with the number of publications growing year by year. Moreover, nowadays, there is already a scientific community devoted to FS. In this work, a general picture of the scientific landscape of FS is drawn by bibliometric analysis. The target sources, the most relevant documents, hot and trending topics as well as the social networking of FS are unveiled. A separate bibliometric analysis is also provided for Reaction or Reactive Flash Sintering (RFS), where not only the sintering, but also the synthesis is merged into a single step. To the best of our knowledge, this is the first study of this nature carried out in this field of research and it can constitute a useful tool for researchers to be quickly updated with FS as well as to strategize future research and publishing approaches.
| S-EPMC8779415 | biostudies-literature
Project description:BackgroundIntermittent measurement of respiratory rate via observation is routine in many patient care settings. This approach has several inherent limitations that diminish the clinical utility of these measurements because it is intermittent, susceptible to human error, and requires clinical resources. As an alternative, a software application that derives continuous respiratory rate measurement from a standard pulse oximeter has been developed. We sought to determine the performance characteristics of this new technology by comparison with clinician-reviewed capnography waveforms in both healthy subjects and hospitalized patients in a low-acuity care setting.MethodsTwo independent observational studies were conducted to validate the performance of the Medtronic Nellcor Respiration Rate Software application. One study enrolled 26 healthy volunteer subjects in a clinical laboratory, and a second multicenter study enrolled 53 hospitalized patients. During a 30-minute study period taking place while participants were breathing spontaneously, pulse oximeter and nasal/oral capnography waveforms were collected. Pulse oximeter waveforms were processed to determine respiratory rate via the Medtronic Nellcor Respiration Rate Software. Capnography waveforms reviewed by a clinician were used to determine the reference respiratory rate.ResultsA total of 23,243 paired observations between the pulse oximeter-derived respiratory rate and the capnography reference method were collected and examined. The mean reference-based respiratory rate was 15.3 ± 4.3 breaths per minute with a range of 4 to 34 breaths per minute. The Pearson correlation coefficient between the Medtronic Nellcor Respiration Rate Software values and the capnography reference respiratory rate is reported as a linear correlation, R, as 0.92 ± 0.02 (P < .001), whereas Lin's concordance correlation coefficient indicates an overall agreement of 0.85 ± 0.04 (95% confidence interval [CI] +0.76; +0.93) (healthy volunteers: 0.94 ± 0.02 [95% CI +0.91; +0.97]; hospitalized patients: 0.80 ± 0.06 [95% CI +0.68; +0.92]). The mean bias of the Medtronic Nellcor Respiration Rate Software was 0.18 breaths per minute with a precision (SD) of 1.65 breaths per minute (healthy volunteers: 0.37 ± 0.78 [95% limits of agreement: -1.16; +1.90] breaths per minute; hospitalized patients: 0.07 ± 1.99 [95% limits of agreement: -3.84; +3.97] breaths per minute). The root mean square deviation was 1.35 breaths per minute (healthy volunteers: 0.81; hospitalized patients: 1.60).ConclusionsThese data demonstrate the performance of the Medtronic Nellcor Respiration Rate Software in healthy subjects and patients hospitalized in a low-acuity care setting when compared with clinician-reviewed capnography. The observed performance of this technology suggests that it may be a useful adjunct to continuous pulse oximetry monitoring by providing continuous respiratory rate measurements. The potential patient safety benefit of using combined continuous pulse oximetry and respiratory rate monitoring warrants assessment.
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Project description:ObjectiveThe purpose was to explore preceptors, residency program directors (RPDs), and residents' beliefs and intentions in participating in multicenter pediatric resident research projects (PRRPs).MethodsThis exploratory qualitative study used the theory of planned behavior to explore beliefs, attitudes, and intentions toward participation in a multicenter PRRP. Two focus groups were formed: RPDs/preceptors and pharmacy residents. The primary objective was to identify attitudes/salient beliefs, subjective norms, and perceived behavioral controls regarding participation in multicenter PRRPs. The secondary objectives included identifying potential barriers and mitigation strategies for multicenter PRRPs. Descriptive statistics and a thematic analysis were performed.ResultsThe 2 focus groups included 24 participants: RPDs/preceptors (n = 16) and pharmacy residents (n = 8). The RPD/preceptor group had a mean of 7.4 ± 5.4 years of research experience; all residents had prior research experience as students. Participants shared and contrasted their salient beliefs, subjective norms, and perceived behavioral control beliefs about logistical challenges, networking, mentoring, sample size, collaboration, workload, shared responsibilities for data collection and the institutional review board application, and resources associated with participation in multicenter PRRPs. Other items that participants felt were important were discussion of authorship order and dedicated research time for residents.ConclusionsParticipants provided favorable comments toward multicenter PRRPs but acknowledged some barriers. The resident, preceptor, and RPD intention to participate in multi-center PRRPs is very likely if they perceive this as an opportunity for increased networking and mentorship, increased likelihood of publication, enhanced research skill experience, and shared resources and responsibilities.
| S-EPMC8475803 | biostudies-literature
Project description:ObjectiveFor psychiatry research resident career development, there is a recognized need for improved cross-institutional mentoring and networking opportunities. One method to address this need is via regional conferences, open to current and recently graduated research residents and their mentors. With this in mind, we developed the biennial California Psychiatry Research Resident Retreat (CPRRR) and collected feedback from participants to 1) Assess resident satisfaction, 2) Determine the utility of the retreat as a networking and mentorship tool, and 3) Identify areas for improvement.MethodsWe gathered survey data from resident attendees at the two first CPRRRs. We analyzed the data to look for trends in satisfaction as well as areas that need improvement.ResultsThirty-two residents from five California training programs attended the CPRRR in 2013 while 33 attended from six programs in 2015. The residents were from all years of training, but concentrated in their second and third years. Approximately 41% and 49% of the attendees were female and 53% and 39% had an MD/PhD in 2013 and 2015, respectively. Twenty-four and 32 residents provided anonymous feedback in 2013 and 2015, respectively. Mean feedback scores were very high (> 4/5) for overall satisfaction, peer- and faculty-networking, the keynote speaker and the flash talks for both years. Mean feedback scores for the ethics debates and mentoring sessions were somewhat lower (≤ 4/5), however, both showed significant improvement from 2013 to 2015.ConclusionThe CPRRRs appear to be an effective mechanism for providing psychiatry research residents with a meaningful cross-institutional opportunity for networking and mentorship. Feedback-driven changes to the CPRRRs improved participant satisfaction for several components of the conference. Future efforts will be aimed at broadening mentorship and networking opportunities, optimizing teaching approaches for research ethics, and considering different feedback-gathering approaches to allow for improved longitudinal follow-up and subgroup analysis.
| S-EPMC5107358 | biostudies-literature