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The reasons underlying prolonged waiting lists for surgery in Ireland are multifactorial. Patient-related factors including non-attendances contribute in part to the current waiting times.To determine the rate of short notice cancellation for day case surgery in a model 2 HSE hospital over a 1-month period and to implement an intervention to try and reduce the rate of cancellation.The cancellation rate was documented over a 1-month period in the hospital. An intervention was then implemented, involving a phone call to the patient from a member of the surgical team to attempt to reduce the cancellation rate. Cancellations were re-audited after the implementation of the phone intervention.The initial audit revealed a cancellation rate of 39.7% during the first month prior to implementation of the phone intervention. A phone call intervention from a member of the surgical team was associated with a decrease in cancellations from 39.7 to 14.6% (p 0.01).While cancellations remained high even after our intervention, a simple phone call was effective and more than halved our cancellation rate. Future efforts need to focus on increasing awareness of patient responsibility for attending scheduled appointments and procedures.

Abstract There is currently an urgent need to identify factors predictive of immunogenicity in colorectal cancer (CRC). Mucinous CRC is a distinct histological subtype of CRC, associated with a poor response to chemotherapy. Recent evidence suggests the commensal facultative anaerobe Fusobacterium may be especially prevalent in mucinous CRC. The objectives of this study were to assess the association of Fusobacterium abundance with immune cell composition and prognosis in mucinous CRC. Our study included two independent colorectal cancer patient cohorts, The Cancer Genome Atlas (TCGA) cohort, and a cohort of rectal cancers from the Beaumont RCSI Cancer Centre (BRCC). Multiplexed immunofluorescence staining of a tumour microarray (TMA) from the BRCC cohort was undertaken using Cell DIVE technology. Our cohorts included 87 cases (13.3%) of mucinous and 565 cases (86.7%) of non-mucinous CRC. Mucinous CRC in the TCGA dataset was associated with an increased proportion of CD8 + lymphocytes (p = 0.018), regulatory T-cells (p = 0.001) and M2 macrophages (p = 0.001). In the BRCC cohort, mucinous RC was associated with enhanced CD8 + lymphocyte (p = 0.022), regulatory T-cell (p = 0.047), and B-cell (p = 0.025) counts. High Fusobacterium abundance was associated with an increased proportion of CD4 + lymphocytes (p = 0.031) and M1 macrophages (p = 0.006), whilst M2 macrophages (p = 0.043) were under-represented in this cohort. Patients with increased Fusobacterium relative abundance in our mucinous CRC TCGA cohort tended to have better clinical outcomes (DSS: likelihood ratio p = 0.04, logrank p = 0.052). Fusobacterium abundance may be associated with improved outcomes in mucinous CRC, possibly due to a modulatory effect on the host immune response. Key messages • Increased Fusobacterium relative abundance was not found to be associated with microsatellite instability in mucinous CRC. • Increased Fusobacterium relative abundance was associated with an M2/M1 macrophage switch, which is especially significant in mucinous CRC, where M2 macrophages are overexpressed. • Increased Fusobacterium relative abundance was associated with a significant improvement in disease specific survival in mucinous CRC. • Our findings were validated at a protein level within our own in house mucinous and non-mucinous rectal cancer cohorts.

The accretion of matter onto black holes and neutron stars often leads to the launching of outflows that can greatly affect the environments surrounding the compact object. In supermassive black holes, these outflows can even be powerful enough to dictate the evolution of the entire host galaxy, and yet, to date, we do not understand how these so-called accretion disk winds are launched - whether by radiation pressure, magnetic forces, thermal irradiation, or a combination thereof. An important means of studying disk winds produced near the central compact object is through X-ray absorption line spectroscopy, which allows us to probe outflow properties along a single line of sight, but usually provides little information about the global 3D disk wind structure that is vital for understanding the launching mechanism and total wind energy budget. Here, we study Hercules X-1, a unique, nearly edge-on X-ray binary with a warped accretion disk precessing with a period of about 35 days. This disk precession results in changing sightlines towards the neutron star, through the ionized outflow. We perform time-resolved X-ray spectroscopy over the precession phase and detect a strong decrease in the wind column density by three orders of magnitude as our sightline progressively samples the wind at greater heights above the accretion disk. The wind becomes clumpier as it rises upwards and expands away from the neutron star. Modelling the warped disk shape, we create a 2D map of wind properties. This unique measurement of the vertical structure of an accretion disk wind allows direct comparisons to 3D global simulations to reveal the outflow launching mechanism., Published in Nature Astronomy on April 10, available at https://www.nature.com/articles/s41550-023-01929-7

Constipation is a very common emergency room complaint and is often multifactorial. Clinicians should have a high index of suspicion for Hirschsprung’s disease in infants who fail to pass meconium within the first 24 hours after delivery or who have a history of infrequent explosive bowel movements and poor weight gain. Examination can reveal abdominal distention, tight anal sphincter, and empty rectum with expulsion of gas and stool (positive “squirt sign”). Abdominal radiographs and contrast enemas can help to diagnose a distal obstruction or transition zone but may also be normal. Rectal biopsy is the gold standard for diagnosis. It is important to be mindful of complications of Hirschsprung’s disease, such as colonic perforation and enterocolitis, as these can occur years after surgical repair and have high rates of mortality.

Bloody stools in a neonate can be from a variety of etiologies such as benign anal fissures or milk protein allergy, or from more life-threatening etiologies such as volvulus, infectious colitis, or necrotizing enterocolitis (NEC). Older children may have bloody stools associated with intussusception, usually diagnosed with ultrasound, and treated with contrast enema or Meckel’s diverticulum diagnosed with a technetium scintigraphy. NEC is most commonly seen in premature infants but must be excluded in infants presenting to the Emergency Department with bloody stools. An abdominal radiograph is the initial imaging modality of choice for the diagnosis of NEC. Pathognomonic features of NEC seen on x-ray include pneumatosis intestinalis (air within the bowel wall), portal vein air, or pneumoperitoneum from intestinal perforation. NEC should be managed with IV fluids, bowel rest with gastric decompression, IV antibiotics, and surgical consultation.

OBJECTIVE To investigate the effects and duration of orally administered prednisolone on renal function evaluated by glomerular filtration rate (GFR) determination and creatinine (Cr) and symmetric dimethylarginine (SDMA) concentrations as well as on urinalysis, electrolytes, and hydric status in healthy dogs. ANIMALS 14 healthy Beagles. PROCEDURES In this prospective double-masked placebo-controlled study, dogs were randomized after baseline evaluation to receive a 7-day course of either prednisolone (1.5 to 2.0 mg/kg, PO, q 12 h) or a placebo. A repeated-measure design was performed, each dog participating in 4 successive sampling sessions. Clinical data, systolic blood pressure, CBC, and biochemical analyses including serum SDMA concentration, GFR determination, urine output quantification, and complete urinalysis were performed for all dogs the day before (D0) and at the end of steroid administration (D7) as well as 2 weeks (D21) and 4 weeks (D35) after the end of treatment. RESULTS At D7, when compared with baseline, GFR increased significantly in treated dogs, whereas creatinine and SDMA concentrations decreased significantly. GFR and Cr but not SDMA modifications persisted significantly at D21. None of the variables differed significantly from baseline at D35. The OR of presenting an albumin band on urine electrophoresis was 2.4 times as high in treated versus control dogs (OR, 36; 95% CI, 1.8 to 719.4; P = 0.02). CLINICAL RELEVANCE A short-term course of immune-suppressive prednisolone treatment in healthy dogs leads to a sustained but reversible renal hyperfiltration state. Modification in electrolytic variables can affect the clinical interpretation of blood work in such patients.

Previously, we modelled the X-ray spectra of the narrow-line Seyfert 1 galaxy IRAS 13224$-$3809 using a disc reflection model with a fixed electron density of $10^{15}$ cm$^{-3}$. An additional blackbody component was required to fit the soft X-ray excess below 2 keV. In this work, we analyse simultaneously five flux-resolved XMM-Newton spectra of this source comprising data collected over 2 Ms. A disc reflection model with an electron density of $n_{\rm e}\approx10^{20}$ cm$^{-3}$ and an iron abundance of $Z_{\rm Fe}=3.2\pm0.5Z_{\odot}$ is used to fit the broad-band spectra of this source. No additional component is required to fit the soft excess. Our best-fit model provides consistent measurements of black hole spin and disc inclination angle as in previous models where a low disc density was assumed. In the end, we calculate the average illumination distance between the corona and the reflection region in the disc of IRAS 13224$-$3809 based on best-fit density and ionisation parameters, which changes from 0.43$\sqrt{f_{\rm AD}/f_{\rm INF}}$ $r_{\rm g}$ in the lowest flux state to 1.71$\sqrt{f_{\rm AD}/f_{\rm INF}}$ $r_{\rm g}$ in the highest flux state assuming a black hole mass of $2\times10^{6}M_{\odot}$. $f_{\rm AD}/f_{\rm INF}$ is the ratio between the flux of the coronal emission that reaches the accretion disc and infinity. This ratio depends on the geometry of the coronal region in IRAS 13224$-$3809. So we only discuss its value based on the simple `lamp-post' model, although detailed modelling of the disc emissivity profile of IRAS 13224$-$3809 is required in future to reveal the exact geometry of the corona., Comment: 17 pages, 15 figures including appendices; accepted for publication in MNRAS

Our study evaluated whether exposure to naphthenic acid fraction compounds (NAFCs) extracted from oil sands process-affected waters (OSPW) has adverse effects on fish embryos that persist into later life. We exposed fathead minnow (Pimephales promelas) embryos to concentrations of NAFCs found in OSPW (2.5-54 mg/L) for 7 days (1 day postfertilization to hatch), then raised surviving larvae in outdoor mesocosms of uncontaminated lake water for 1 month. Embryos exposed to NAFCs were more likely to exhibit malformations (by up to 8-fold) and had slower heart rates (by up to 24%) compared to controls. Fish raised in uncontaminated lake water following exposure to NAFCs as embryos, were 2.5-fold less likely to survive during the larval stage than control fish. These fish also showed up to a 45% decrease in swim activity and a 36% increase in swim burst events during behavioral tests relative to controls. We conclude that exposure to NAFCs during the embryonic stage can have lasting effects on fish survival, physiology, and behavior that persist at least through the larval stage. These findings of delayed mortalities and persistent sublethal effects of embryonic NAFC exposure are relevant to informing the development of regulations on treated OSPW releases from mining operations. Environ Toxicol Chem 2022;41:1319-1332. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

The process of adopting evidence-based educational practices and teaching methods has not been examined in nursing education.This article provides a framework for adopting educational evidence and designing studies in nursing education using an implementation science (IS) framework.The three phases for implementing evidence-based practices (development, translation, and sustainment) are used for this framework.Preparatory activities are needed before implementing a new educational practice or method, followed by identification of implementation strategies (e.g., training and support of faculty, strategies for communication and tips to remove barriers, guides for deciding on timing), assessing process and outcome measures, and plans for sustaining the new practice. A process map, examples of implementation processes, and sample research questions guide nurse educators in planning and conducting studies using an IS framework.Research has not examined the processes and strategies for applying evidence-based educational practices in nursing. Studies using an IS framework are needed to provide knowledge about how to move evidence into routine educational practices and implement more effective teaching methods. This article provides guidance for nurse educators to begin this research and suggests possible research questions.

The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system.Evidence to support which staffing variables influence fall performance so that health care organizations can better allocate resources is lacking.A descriptive study design was used to analyse the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables.A total of nine units were included (five high and four low performing). Higher performing units showed less use of sitters and travellers, had fewer overtime hours worked by nurses, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units.Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes.Nursing managers may consider trying to reduce use of sitters and travellers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.

Hospitals continue to struggle with preventable healthcare-associated infections. Whereas the focus is generally on proactive prevention processes, performing retrospective case reviews of infections can identify opportunities for quality improvement and maximize learning from defects. This brief article provides practical information for structuring the case review process using readily available health system platforms. Using a structured approach for case reviews can help identify trends and opportunities for improvement.

Nursing leaders must engage with evidence-based practice (EBP) to advance quality patient care. The purpose of this study was to understand the impact of an implementation science study on nurse manager competencies. Qualitative focus group interviews were conducted with leaders following an implementation science study. The AONL Nurse Manager Competency Framework was used as a guide. Leaders felt they were able to promote EBPs, influence others, and grow in their professional role after participating in the implementation science study. Involvement in nurse-led implementation science research can enhance frontline leaders’ ability to engage with and promote EBP.

Brain-computer interfaces (BCIs) are neural prosthetics that enable closed-loop electrophysiology procedures. These devices are currently used in fundamental neurophysiology research, and they are moving toward clinical viability for neural rehabilitation. State-of-the-art BCI experiments have often been performed using tethered (wired) setups in controlled laboratory settings. Wired tethers simplify power and data interfaces but restrict the duration and types of experiments that are possible, particularly for the study of sensorimotor pathways in freely behaving animals. To eliminate tethers, there is significant ongoing research to develop fully wireless BCIs having wireless uplink of broadband neural recordings and wireless recharging for long-duration deployment, but significant challenges persist. BCIs must deliver complex functionality while complying with tightly coupled constraints in size, weight, power, noise, and biocompatibility. In this article, we provide an overview of recent progress in wireless BCIs and a detailed presentation of two emerging technologies that are advancing the state of the art: ultralow-power wireless backscatter communication and adaptive inductive resonant (AIR) wireless power transfer (WPT).

We use numerical hydrodynamics simulations to study line driven winds launched from an accreting alpha-disc. Building on previous work where the driving radiation field is static, we compute a time-dependent radiation flux from the local, variable accretion rate of the disc. We find that prior to the establishment of a steady state in the disc, variations of ~ 15% in disc luminosity correlate with variations of ~ 2-3 in the mass flux of the wind. After a steady state is reached, when luminosity variations drop to ~ 3%, these correlations vanish as the variability in the mass flux is dominated by the intrinsic variability of the winds. This is especially evident in lower luminosity runs where intrinsic variability is higher due to a greater prevalence of failed winds. The changing mass flux occurs primarily due to the formation of clumps and voids near the disc atmosphere that propagate out into the low velocity part of the flow, a process that can be influenced by local variations in disc intensity. By computing the normalised standard deviation of the mass outflow, we show that the impact of luminosity variations on mass outflow is more visible at higher luminosity. However, the absolute change in mass outflow due to luminosity increases is larger for lower luminosity models due to the luminosity-mass flux scaling relation becoming steeper. We further discuss implications for CVs and AGN and observational prospects., 12 pages, 7 figures, accepted for publication in MNRAS

Murray-Darling Freshwater Research CentreMDFRC item.The interactions of size, shape, and density of cyanobacteria result in a 5-order of magnitude difference in flotation or sinking rates which, in turn, influence the extent of their dispersion in turbulent water masses. Active mixing through resource-replete waters of high clarity favours fast-growing, small-celled species. Where photosynthetically active radiation is severely attenuated through the wind-mixed layer, species may rely on turbulent entrainment but must be adapted toward efficient light harvesting (morphological attenuation, enhanced pigmentation). In both strongly segregated waters (light- and nutrient-rich layers separated vertically) and waters experiencing high-frequency fluctuations in vertical mixing and optical depth, emphasis is placed on the ability to make rapid, buoyancy-adjusted vertical movements, favoured by large size. The cyanobacterial 1ife-forms respectively typical of these contrasted limnological systems — unicellular coccoids (e.g., Synechococcus), solitary filaments (e.g., Oscillatoria) and colonial forms (e.g., Microcystis) — illustrate the diversity of evolutionary adaptations to be discerned among the planktonic cyanobacteria and which contributes to their reputation as a prominent and successful group of organisms.

Axion-Like Particles (ALPs) are predicted by several Beyond the Standard Model theories, in particular, string theory. In the presence of an external magnetic field perpendicular to the direction of propagation, ALPs can couple to photons. Therefore, if an X-ray source is viewed through a magnetised plasma, such as a luminous quasar in a galaxy cluster, we may expect spectral distortions that are well described by photon-ALP oscillations. We present a $571 \ \mathrm{ks}$ combined High and Low Energy Transmission Grating (HETG/LETG) Chandra observation of the powerful radio-quiet quasar H1821+643, hosted by a cool-core cluster at redshift $0.3$. The spectrum is well described by a double power-law continuum and broad$+$narrow iron line emission typical of type-1 Active Galactic Nuclei (AGN), with remaining spectral features $< 2.5\%$. Using a cell-based approach to describe the turbulent cluster magnetic field, we compare our spectrum with photon-ALP mixing curves for 500 field realisations assuming that the thermal-to-magnetic pressure ratio remains constant up to the virial radius. At $99.7\%$ credibility and taking $��= 100$, we exclude all couplings $g_\mathrm{a��} > 6.3 \times 10^{-13} \ {\mathrm{GeV}}^{-1}$ for most ALP masses $< 10^{-12} \ \mathrm{eV}$. Our results are moderately more sensitive to constraining ALPs than the best previous result from Chandra observations of the Perseus cluster, albeit with a less constrained field model. We reflect on the promising future of ALP studies with bright AGN embedded in rich clusters, especially with the upcoming Athena mission., 14 pages, 7 figures. Accepted for publication in MNRAS on 24th November 2021. Comments welcome

Central line-associated bloodstream infections (CLABSIs) are a common, preventable healthcare-associated infection. In our 3-hospital health system, CLABSI rates in non-intensive care unit (ICU) settings were above the internal target rate of zero. A robust quality improvement (QI) project to reduce non-ICU CLABSIs was undertaken by a team of Doctor of Nursing Practice (DNP)-prepared nurse leaders enrolled in a post-DNP Quality Implementation Scholars program and 2 QI experts. Based on a review of the literature and local root cause analyses, the QI team implemented the evidence-based practice of using 2% chlorhexidine gluconate (CHG) cloths for daily bathing for non-ICU patients with a central line.A pre-post-design was used for this QI study. CHG bathing was implemented using multifaceted educational strategies that included an e-learning module, printed educational materials, educational outreach, engagement of unit-based CLABSI champions, and an electronic reminder in the electronic health record. Generalized linear mixed-effects models were used to assess the change in CLABSI rates before and after implementation of CHG bathing. CLABSI rates were also tracked using statistical process control (SPC) charts to monitor stability over time. CHG bathing documentation compliance was audited as a process measure. These audit data were provided to unit-based leadership (nurse managers and clinical team leaders) on a monthly basis. A Qualtrics survey was also disseminated to nursing leadership to evaluate their satisfaction with the CHG bathing implementation processes.Thirty-four non-ICU settings participated in the QI study, including general medical/surgical units and specialty areas (oncology, neurosciences, cardiac, orthopedic, and pediatrics). While the change in CLABSI rates after the intervention was not statistically significant (b = -0.35, P = .15), there was a clinically significant CLABSI rate reduction of 22.8%. Monitoring the SPC charts demonstrated that CLABSI rates remained stable after the intervention at all 3 hospitals as well as the health system. CHG bathing documentation compliance increased system-wide from 77% (January 2020) to 94% (February 2021). Overall, nurse leaders were satisfied with the CHG bathing implementation process.To sustain this practice change in non-ICU settings, booster sessions will be completed at least on an annual basis. This study provides further support for using CHG cloths for daily patient bathing in the non-ICU setting.

Background Standard urine culture collection techniques have a high risk of false positive results in catheterized patients. IDSA guidelines recommend replacing long-term catheters before specimen collection for cultures. Our goal was to evaluate the impact of clinical decision support (CDS) during the urine culture computerized provider order entry (CPOE) on test use and patient-level outcomes. Methods In March 2021, CDS was added to the urine culture CPOE in the electronic health record (EHR). The order panel includes education regarding appropriate clinical indications for urine culturing, and protocolizes urine collection to determine (A) if a urinalysis was ordered, (B) if special patient population (i.e., PICU), (C) the presence and duration of an indwelling urinary catheter, and (D) whether the catheter had difficulty with placement. Depending on the criteria identified in A, B, C, and D, the panel recommends catheter removal prior to urine culture (Figure 1). We retrospectively evaluated the impact of panel implementation in our pre- (7/2020- 3/2021) and post-intervention periods (4/2021- 3/2022) using an interrupted time series analysis with Poisson regression. Outcomes included urine cultures/1000 patient days (pd), number of catheter removal orders, catheter-associated urinary tract infection (CAUTI)/1000 catheter days, and days of antibiotic therapy with urinary tract infection (UTI) indication/1000pd Order Panel Framework Results Clinicians selected catheter removal in 183 of 2133 (8.5%) instances of ordering a urine culture when a catheter was detected by the panel (Figure 2). Analysis revealed a significant decrease in urine culture orders (1.1% decrease/month, p< 0.05), a decreasing trend of antibiotic use with UTI indications (Figure 3, 2.8% decrease/month, p< 0.05), but no significant change in CAUTI rates (Figure 4). Evaluation of the safety reporting system revealed no identifiable increase in safety events related to catheter removal or reinsertion. Catheter Associated Urinary Tract Infections Black boxes indicate Poisson regression model estimates Black boxes indicate Poisson regression model estimates Conclusion CDS can aid in improving urine culture practice habits, including removal of long-standing catheters before urine culture. The decreasing trend in total urine culture orders (Figure 5) may reflect a ”culture change” over time to avoid urine cultures in inappropriate instances. Total Urine Cultures Ordered Black boxes indicate Poisson regression model estimates. Red circles indicate predicted outcome without ‘intervention’. Disclosures Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant.