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ObjectivePathways are succinct, operational versions of evidence-based guidelines. Studies have demonstrated pathways improve quality of care for children hospitalized with asthma, but we have limited information on other key factors to guide hospital leaders and clinicians in pathway implementation efforts. Our objective was to evaluate the adoption, implementation, and reach of inpatient pediatric asthma pathways.MethodsThis was a mixed-methods study of hospitals participating in a national collaborative to implement pathways. Data sources included electronic surveys of implementation leaders and staff, field observations, and chart review of children ages 2-17 years admitted with a primary diagnosis of asthma. Outcomes included adoption by hospitals, pathway implementation factors, and reach of pathways to children hospitalized with asthma. Quantitative data were analyzed using descriptive statistics and multivariable regression. Qualitative data were analyzed using thematic content analysis.ResultsEighty-five hospitals enrolled; 68 (80%) adopted/completed the collaborative. These 68 hospitals implemented pathways with overall high fidelity, implementing a median of 5 of 5 core pathway components (Interquartile Range [IQR] 4-5) in a median of 5 months (IQR 3-9). Implementation teams reported a median time cost of 78 h (IQR: 40-120) for implementation. Implementation leaders reported the values of pathway implementation included improvements in care, enhanced interdisciplinary collaboration, and access to educational resources. Leaders reported barriers in modifying electronic health records (EHRs), and only 63% of children had electronic pathway orders placed.ConclusionsHospitals implemented pathways with high fidelity. Barriers in modifying EHRs may have limited the reach of pathways to children hospitalized with asthma.

Pathways guide clinicians through evidence-based care of specific conditions. Pathways have been demonstrated to improve pediatric asthma care, but mainly in studies at tertiary children's hospitals. Our global aim was to enhance the quality of asthma care across multiple measures by implementing pathways in community hospitals.MethodsThis quality improvement study included children ages 2-17 years with a primary diagnosis of asthma. Data were collected before and after pathway implementation (total 28 mo). Pathway implementation involved local champions, educational meetings, audit/feedback, and electronic health record integration. Emergency department (ED) measures included severity assessment at triage, timely systemic corticosteroid administration (within 60 mins), chest radiograph (CXR) utilization, hospital admission, and length of stay (LOS). Inpatient measures included screening for secondhand tobacco and referral to cessation resources, early administration of bronchodilator via metered-dose inhaler, antibiotic prescription, LOS, and 7-day readmission/ED revisit. Analyses were done using statistical process control.ResultsWe analyzed 881 ED visits and 138 hospitalizations from 2 community hospitals. Pathways were associated with increases in the proportion of children with timely systemic corticosteroid administration (Site 1: 32%-57%, Site 2: 62%-75%) and screening for secondhand tobacco (Site 1: 82%-100%, Site 2: 54%-89%); and decreases in CXR utilization (Site 1: 44%-29%), ED LOS (Site 1: 230-197 mins), and antibiotic prescription (Site 2: 23%-3%). There were no significant changes in other outcomes.ConclusionsPathways improved pediatric asthma care quality in the ED and inpatient settings of community hospitals.

Here, we propose a composite system made of 2D-[Ti.sub.3][C.sub.2] and two different chemical forms of polyaniline (PANI) like polyemeraldine base (EB) and polyemeraldine salt (ES) to investigate their electrochemical performances as supercapacitor electrode material. Fundamentally, EB and ES are having different functionalities and electrical conductivities to affect their electrochemical performances. Thus, synthesis and electrochemical performances of the composites made of [Ti.sub.3][C.sub.2] and ES or EB with different compositions is discussed where [Ti.sub.3][C.sub.2]/ES form of PANI appears as best performing supercapacitor electrode with the areal capacitance of 1.85 [Fcm.sup.-2] at 5 [mVs.sup.-1]. A capacitance enhancement of 5.4 times was observed for [Ti.sub.3][C.sub.2]/PANI-ES while compared to the same for bare [Ti.sub.3][C.sub.2] with capacity retention of 91.70% after 500 cycles at 1 [Ag.sup.-1]. This work has also explored the effect of composite compositions by varying the stoichiometric weight ratios of [Ti.sub.3][C.sub.2] and different forms of PANI to achieve high-performing supercapacitor electrode materials. KEYWORDS interfacial charge transfer, MXene, polyaniline, polyemeraldine salt, supercapacitor, 1 | INTRODUCTION Energy and environmental issues are the greatest challenges faced by humanity in the 21st century. Exploration and utilization of new energy sources including wind and solar energy [...]

Background In 2021, the US FDA issued a new checklist, labeling, and rupture-screening recommendations for breast implants to improve the decision-making process. Objectives The aim of this study was to understand plastic surgeons' perspective on these changes and their perceived impact on clinical practice. Methods In September 2023, a 27-question multiple-choice cross-sectional survey was distributed to 4352 active members of the American Society of Plastic Surgeons to evaluate attitudes on the FDA's black-box warning, informed decision checklist, and updated rupture-screening recommendations. Results A total of 591 responses were collected (13.6%). The majority of respondents were between the ages of 45 and 64 years (58%) and had been in practice for more than 20 years (52%). Surgeons felt that some additions were appropriate; however, the majority (57%) stated that the informed decision checklist did not have a positive impact on workflow; 66% were also neutral or disagreed with the reported incidence rates related to complications and cancer. Nearly half of respondents (47%) did not feel the black-box warning improved their patients' understanding of the risks and benefits. Additionally, 47% of respondents also believed these requirements, in combination, did not improve the overall patient experience with implants. Conclusions Respondents had an overall positive response towards the addition of risk information provided by the FDA-issued guidance and updates to rupture-screening recommendations. However, they remained divided as to whether the black-box warning and patient decision checklist had an overall positive impact on clinical practice patterns. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

The health landscape of India is changing fast due to the impacts of globalization and urbanization, bringing in changes in lifestyles and food consumption patterns in urban areas. The current study aims to explore the linkages between health orientation (HO) and the consumption trends of high-value agricultural products (HVAP) among urban Indian consumers. Structural equation modeling (SEM) and analysis of variance (ANOVA) have been conducted using the data collected through a primary survey of 385 individuals in Delhi. The results show that HO explains 54.8% of the total HVAP consumption. Within the HVAP basket, consumption of fruits, vegetables, milk, and eggs has been found to be affected more by HO, compared to meat and fish. The socio-economic factors, such as education, gender, family size, monthly income, etc. build the health orientation of consumers more significantly and thus have been found to be the dominant determining factors behind HVAP consumption. [ABSTRACT FROM AUTHOR]

In the present work, a microwave sensor is proposed for detection of conductivity of the material. The sensor consists of a planar complementary circular ring structure etched on the top of the single sided copper clad substrate material and a shallow groove machined at the bottom surface coinciding with the ring structure. The conducting material under test (MUT), curved in the form of a split ring is placed in the groove. The proposed microwave sensor is particularly designed to work at 5.2 GHz Wi-Fi frequency. The key concept is the interaction of the EM wave with the material of different conductivity which results in change in reflection coefficient owing to different depth of penetration at a particular frequency. A reference set is generated by recording the variation in reflection coefficient for different materials, which is the main parameter in distinguishing between materials of different conductivities. The sensor dimension is 4 cm X 4 cm (0.083277 λg), λg being the guide wavelength, the MUT is a wire of length 4 cm with thickness ≤ 1 mm placed in form of circular split ring within the groove. The sensor corresponds to sensitivity of 3.6 dB/unit change in electrical conductivity. The proposed sensor facilitates rapid and convenient detection of the conductivity of the material. [ABSTRACT FROM AUTHOR]

Background Breast cancer-related lymphedema is the most common cause of lymphedema in the United States and occurs in up to 50% of individuals receiving axillary lymph node dissection (ALND). Lymphovenous bypass (LVB) at the time of ALND may prevent lymphedema, but long-term results and anastomotic patency are unclear. This study evaluates the feasibility and outcomes of performing immediate lymphatic reconstruction via coupler-assisted bypass (CAB). Methods This is a retrospective review of all patients undergoing prophylactic LVB following ALND at two tertiary care centers between 2018 and 2022. Patients were divided into cohorts based on whether they received the "standard" end-to-end (E-E) suturing or CAB technique. The primary outcome of interest was development of lymphedema. Quantitative and qualitative assessments for lymphedema were performed preoperatively and at 3, 6, 12, and 24 months postoperatively. Results Overall, 63 LVBs were performed, of which 24 lymphatics underwent immediate reconstruction via "CAB" and 39 lymphatics via "standard" end-to-end suture. Patient characteristics, including body mass index, and treatment characteristics, including radiation therapy, did not significantly differ between groups. CAB was associated with a greater mean number of lymphatics bypassed per vein (standard 1.7 vs. CAB 2.6, p = 0.0001) and bypass to larger veins (standard 1.2 vs. CAB 2.2 mm, p < 0.0001). At a median follow-up of 14.7 months, 9.1% (1/11) of individuals receiving CAB developed lymphedema. These rates were similar to those seen following standard bypass at 4.8% (1/21), although within a significantly shorter follow-up duration (standard 7.8 vs. CAB 14.7 months, p = 0.0170). Conclusion The CAB technique is a viable, effective technical alternative to the standard LVB technique. This comparative study of techniques in prophylactic LVB suggests that CABs maintain long-term patency, possibly due to the ease of anastomosing several lymphatics to single large caliber veins while reducing the technical demands of the procedure. [ABSTRACT FROM AUTHOR]

Background In patients with chronic lower extremity (LE) wounds, chronic osteomyelitis confers additional complexity to achieving adequate treatment. Previous reviews demonstrate increased rates of osteomyelitis recurrence in patients who receive muscle flaps compared with fasciocutaneous flaps for LE limb salvage; however, these studies were not limited to atraumatic populations who receive exclusively free flaps. Thus, this study compared rates of recurrence in chronic osteomyelitis patients undergoing LE reconstruction with fasciocutaneous versus muscle free flaps. Methods Patients undergoing free tissue transfer (FTT) between July 2011 and July 2021 were retrospectively reviewed. Patients were stratified into fasciocutaneous and muscle free flap groups. Primary outcomes included osteomyelitis recurrence, flap complications, limb salvage, and ambulatory status. Results Forty-eight patients with pathologic diagnosis of chronic osteomyelitis of the wound bed were identified, of which 58.3% received fasciocutaneous (n = 28) and 41.7% received muscle flaps (n = 20). The most common comorbidities included diabetes mellitus (n = 29, 60.4%), peripheral neuropathy (n = 27, 56.3%) and peripheral vascular disease (n = 24, 50.0%). Methicillin-resistant or methicillin -sensitive Staphylococcus aureus were the most common pathogen in 18.7% (n = 9) of procedures. The majority of patients underwent a median of three debridements followed by negative pressure wound therapy prior to receiving FTT. At a median follow-up of 16.6 months, the limb salvage and ambulatory rates were 79.2 (n = 38) and 83.3% (n = 40), respectively. The overall rate of microsurgical flap success was 93.8% (n = 45). Osteomyelitis recurred in 25% of patients (n = 12) at a median duration of 4.0 months. There were no significant differences in rates of osteomyelitis recurrence, flap complications, limb salvage, ambulation, and mortality. On multivariate analysis, flap composition remained a nonsignificant predictor of osteomyelitis recurrence (odds ratio: 0.975, p = 0.973). Conclusion This study demonstrates that flap composition may not influence recurrence of osteomyelitis following free flap reconstruction of chronic LE wounds, suggesting that optimal flap selection should be based on wound characteristics and patient goals. [ABSTRACT FROM AUTHOR]

In this paper cluster-based hybrid MAC (CB-HMAC) protocol, based on IEEE 802.15.4 MAC is proposed for smart home networks. The CB-HMAC is specially designed for short packet transmission in a dense home network environment. Simulation results show that the proposed CB-HMAC is more energy-efficient than other medium access control (MAC) protocols without sacrificing much delay and throughput.