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PURPOSE: The utilization of the hospitalist care model has increased over the past decade because of improved cost-effectiveness, quality of care, and value that it provides. Studies have shown that compared with the traditional care model, use of hospitalists provides cost-saving and improved value to hospital systems. However, the data for the use of oncology hospitalists (ONC Hosp) are sparse. In this study, we investigate the impact of inpatient ONC Hosp on 30-day readmissions, length of stay (LOS), discharge to hospice, and inpatient mortality when compared with a traditional model where outpatient oncologists manage the acute issues of hospitalized patients with cancer. METHODS: Rhode Island Hospital hired ONC Hosps to attend on the inpatient oncology service. To determine the impact of this new patient care model, we performed a retrospective review of oncology patients admitted to Rhode Island Hospital between July 1, 2012, and June 30, 2018, and compared quality outcomes of 30-day readmission, LOS, discharge to hospice, and inpatient mortality to those from the traditional care model. RESULTS: Compared with outpatient oncologists care, care by ONC Hosp was associated with a significant decrease in 30-day readmissions (23.0% v 29.6%, P = .019) and a significant increase in discharge to hospice (18.1% v 12.1%, P < .001). No significant difference was detected between LOS ( P = .833) or inpatient mortality ( P = .332). CONCLUSION: This study shows that compared with the traditional care model, the use of ONC Hosps has a positive impact on patient care and the potential to add value to the hospital system.

The objective of this study was to examine whether the number of children presenting for emergency psychiatric evaluations for making threats of mass school violence increases in the wake of a school shooting that receives heavy media attention. The records reviewed were for all children who presented to our hospital's pediatric behavioral health emergency service in the 6 weeks before and after the mass shooting at Marjory Stoneman Douglas High School in Parkland, FL, that occurred on February 14, 2018. The inclusion criterion was threat of mass casualty school violence recorded in the encounter history of present illness. The proportion of patients reporting school violence was higher after the Parkland shooting than before ( P = .0164). The mean number of admission days was longer for patients presenting after the Parkland shooting rather than before ( P = .0164), and for those with documented gun access rather than undocumented ( P = .0128). Our findings suggest that school violence threats increase in the weeks after a school shooting in which there was heavy media attention. [ Psychiatr Ann . 2021;51(2):88–94.]

Apoptosis signal-regulating kinase 1 (ASK1/MAP3K) is a mitogen-activated protein kinase family member shown to contribute to acute ischemia/reperfusion injury. Using structure-based drug design, deconstruction, and reoptimization of a known ASK1 inhibitor, a lead compound was identified. This compound displayed robust MAP3K pathway inhibition and reduction of infarct size in an isolated perfused heart model of cardiac injury.

Nephrolithiasis patients undergo repeated imaging increasing their radiation risk. Guidelines recommend imaging following ureteroscopic lithotripsy (URSL), but not the modality or frequency of imaging. As such, we sought to elucidate common imaging practices following URSL and current knowledge of radiation exposure among endourologists.A web-based survey of Endourological Society members was used to evaluate knowledge and clinical practices regarding radiation exposure in post-URSL imaging. Respondents were grouped by years of experience ( 10,= 10 years) and geographic location (USA or non-USA). An interaction term was included in the models to allow response rate to vary across experience level with geographic location and P values were derived from model main effects.A total of 309 respondents answered the survey out of the 1800 active members of the Endourological Society that received the survey (17.2% total response rate). 204 of the respondents were included in our analysis as fellowship trained endourologists that perform URSL with a mean of 13.3 years in practice (IQR 6.75, 20 years). Overall, routine postoperative imaging is performed by 92% of respondents: 97% in the USA and 88% outside the US (P = 0.143). 39% of respondents correctly estimated standard dose CT scan (SCT) dose, while 36% correctly estimated that of a low-dose CT scan (LCT). American urologists correctly identified the SCT radiation dose more often than non-US respondents (54% vs 32%, respectively) (P value = 0.004). Respondents with 10 years of experience more frequently identified the correct SCT dose (52% vs. 34%, respectively), though not significantly so (P value = 0.171). 79% of respondents consider LCT quality to be similar to SCT and 50% would use LCT on obese patients. However, only 26% of respondents identified that image quality deteriorates with BMI 30 kg/mWe demonstrate a knowledge gap regarding radiation exposure during CT scans and the limitations of low-dose CT imaging. This gap is wider in non-US-based urologists and in those with over 10 years of experience. However, all urologists would benefit from improved education and clear guidelines regarding radiation exposure in nephrolithiasis patients.

Aim To explore the education and developmental needs of care home nursing staff. Background With an increasing ageing population, the need for high quality care provision is set to rise and will require nursing staff with the desired knowledge, skills and values. However, multiple concerns have been identified when considering the development of nurses working in care homes. Moreover, challenges in the care home sector have also contributed to a situation where some nurses view care home work as being of low status, and choose this work to fit around other commitments, rather than viewing it as a viable career pathway. Method A qualitative approach based on the principles of Appreciative Inquiry. Fifteen participants working in five care homes with nursing, based in England (UK) took part in this study. Data were collected during 2016 – 2017 and involved managerial, qualified and unqualified staff. Results Data analysis revealed three distinct themes: an effective learning environment; the care home as a nursing student placement; the need for financial investment. These themes were found to have the most influence on the development and education of care home nursing staff. Conclusion This research provides important insights into the care home as an educational environment, not only for nursing students but for those employees already working in such settings. Exploration of the ways in which higher education organisations and care home teams could collaborate more closely could be mutually beneficial to the quality of care and to raising the profile of care home work. Implications for Practice Care homes can provide a rich learning environment for both staff and nursing students. Collaboration and appreciative ways of working enhance opportunities for developing practice and care.

Children with autism spectrum disorder (ASD) can process both interpretations of an ambiguous figure (e.g. rabbit/duck) when told about the ambiguity, however they tend not to do so spontaneously. Here we show that although adolescents with ASD can explicitly experience such ‘reversals’, implicit measures suggest they are conceptually processing the images differently from learning disabled peers. Participants copied the same ambiguous figures under different contextual conditions, both before and after reversal experience. Results suggest that adolescents with ASD are not influenced by contextual information when copying ambiguous drawings, since they produce similar pictures before and after reversal, compared with controls. This research has implications for how individuals with ASD understand multiple representations and supports the Enhanced Perceptual Functioning theory.

It has recently been shown that adapting to a densely textured stimulus alters the perception of visual space, such that the distance between two points subsequently presented in the adapted region appears reduced (Hisakata, Nishida, & Johnston, 2016). We asked whether this form of adaptation-induced spatial compression alters visual crowding. To address this question, we first adapted observers to a dynamic dot texture presented within an annular region surrounding the test location. Following adaptation, observers perceived a test array comprised of multiple oriented dot dipoles as spatially compressed, resulting in an overall reduction in perceived size. We then tested to what extent this spatial compression influences crowding by measuring orientation discrimination of a single dipole flanked by randomly oriented dipoles across a range of separations. Following adaptation, we found that the magnitude of crowding was predicted by the physical rather than perceptual separation between center and flanking dipoles. These findings contrast with previous studies in which crowding has been shown to increase when motion-induced position shifts act to reduce apparent separation (Dakin, Greenwood, Carlson, & Bex, 2011; Maus, Fischer, & Whitney, 2011).

[This corrects the article DOI: 10.1021/acsmedchemlett.6b00481.].

Catalytic couplings were utilized to stereospecifically synthesize several 7 E - and 7 Z -alkylidenecephalosporins. Members of this class are known inhibitors of β-lactamase. Zinc/NH 4 Cl reduction of dibromide 14 stereospecifically produced E -monobromide, 15 . In contrast, treatment of 14 with isopropylmagnesium bromide, followed by mild acid, stereospecifically produced Z -monobromide 27 . These reactions involve stable, intermediate α-(metalloalkylidene)-β-lactams. Monobromides 15 and 27 were stereospecifically coupled to organostannanes, or were converted to the corresponding organostannanes, 22 and 32 , which coupled with organohalides.

Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social learning theory creates a continuum between work-based interprofessional learning and service improvement in which each is integral to the other. This continuum provides a framework for continuing interprofessional development that enables service improvement in the workplace to serve as a vehicle through which individual professionals and teams can continually enhance patient care through working and learning together. The root of this lies in understanding that undertaking improvement and learning about improvement are co-dependent and that health care professionals must recognize their responsibility to improve as well as complete their everyday work. We believe that significant opportunities exist for health care commissioners, service providers, and educational institutions to work together to promote continuing interprofessional development in the workplace to enhance patient outcomes, and we outline some of the opportunities we believe exist.

Summary Background & aims This study defines and quantifies longitudinal changes in quality of life (QoL) at the time of first discharge home on home parenteral nutrition (HPN) and over the first year. Methods Results were compared in patients in standard contact with a nutrition nurse specialist by telephone, with results of those in contact via telemedicine in a randomised controlled trial. Participants were recruited from nine UK HPN centres. Patients were randomised to receive telemedicine upon initial discharge or after 1 year. The SF36 was the principal instrument chosen to determine QoL throughout the year on three predetermined occasions. EQ5D and hospital anxiety and depression scores were also recorded. Results Thirty participants were recruited to the study from March 2001 to June 2003. In all domains, QoL scores were significantly lower than normative data at discharge. QoL scores significantly improved over the first 6 months in physical functioning, physical role (RP), vitality (VT), social functioning (SF), emotional-role (RE) domains, and mental component summary (MCS). At 6 months RE, mental health (MH) and MCS were no longer significantly lower than normative data. There was no significant change in bodily pain (BP), general health (GH), MH, and physical component summary (PCS). Opiate use significantly reduced SF36 domains RP, BP, VT, SF, MH, and MCS at 6 months and was associated with more subsequent inpatient episodes and central line reinsertions. Patients with an acute onset of intestinal failure had less pain and better GH scores at 6 months, and had less inpatient episodes after discharge than patients with a more chronic onset. Telemedicine had no impact on QoL or subsequent clinical outcome. Conclusions Aspects of QoL improve over the first 6 months of HPN. Opiate use and chronic diagnosis have a negative impact on some elements of QoL and clinical outcome variables.

Catalytic couplings were utilized to stereospecifically synthesize several 7 E - and 7 Z -alkylidenecephalosporins. Members of this class are known inhibitors of β-lactamase. Zinc/NH 4 Cl reduction of dibromide 14 stereospecifically produced E -monobromide, 15 . In contrast, treatment of 14 with isopropylmagnesium bromide, followed by mild acid, stereospecifically produced Z -monobromide 27 . These reactions involve stable, intermediate α-(metalloalkylidene)-β-lactams. Monobromides 15 and 27 were stereospecifically coupled to organostannanes, or were converted to the corresponding organostannanes, 22 and 32 , which coupled with organohalides.

As many qualified health professionals are all too aware, the continued success of the NHS depends largely on collaborative interprofessional working across all grades and professions of staff. This is especially important for those working on the front line delivering direct patient centred care; the healthcare assistant (HCA). HCAs working across all disciplines; nursing, midwifery and the allied health professions, to name but a few, have unerringly implemented treatment programmes and provided high quality patient care for a number of years and are valuable members of the healthcare team.