The Quality Improvement Fellow: Educating on Making the Difference.

The critical care medicine (CCM) fellowship is an opportunity for advanced anesthesiology trainees to refine their quality improvement (QI) skills. However, the short training period and inconsistent curricula make this challenging. The QI fellow (QIF) is described as an education program to provide consistent QI training during the CCM fellowship. The QIF is a mentored position to help manage data review, QI conferences, and improvement efforts within the CCM Division. The curriculum is focused on a QI education framework and mentored experiential learning. The QIF program is an opportunity for education and mentorship in the role of a CCM operational leader.

Oxygen consumption rate of Caenorhabditis elegans as a high-throughput endpoint of toxicity testing using the Seahorse XFe96 Extracellular Flux Analyzer.

Caenorhabditis elegans presents functioning, biologically relevant phenotypes and is frequently used as a bioindicator of toxicity. However, most C. elegans in vivo effect-assessment methods are laborious and time consuming. Therefore, we developed a novel method to measure the oxygen consumption rate of C. elegans as a sublethal endpoint of toxicity. This protocol was tested by exposing 50 larval stage one C. elegans individuals for 48 h (at 20 °C) to different concentrations of two toxicants i.e. benzylcetyldimethylammonium chloride (BAC-C16) and cadmium (Cd). Following exposures, the oxygen consumption rate of the C. elegans individuals were measured using the high-throughput functionality of the Seahorse XFe96 Extracellular Flux Analyzer. Dose-response curves for BAC-C16 (R2 = 0.93; P = 0.001) and Cd (R2 = 0.98; P = 0.001) were created. Furthermore, a strong, positive correlation was evidenced between C. elegans oxygen consumption rate and a commonly used, ecologically relevant endpoint of toxicity (growth inhibition) for BAC-C16 (R2 = 0.93; P = 0.0001) and Cd (R2 = 0.91; P = 0.0001). The data presented in this study show that C. elegans oxygen consumption rate can be used as a promising functional measurement of toxicity.

Burden of Sciatica on US Medicare Recipients.

OBJECTIVE: This study evaluates the disease burden of sciatica on the US Medicare cohort. BACKGROUND DATA: Sciatica is a common disability that has important physical, mental, and economic effects. The Medicare Health Outcomes Survey (HOS) is a demographic and outcomes survey used to monitor the performance of Medicare Advantage health plans in the United States. The HOS includes data on demographics, chronic medical conditions, and patient-reported outcomes. METHODS: Medicare HOS data for cohorts from 2007 to 2013 were obtained. Patients were placed into two categories based on the survey results: with or without a history of sciatica. Baseline demographics, chronic medical conditions, and physical health symptoms were aggregated. In addition, average VR-12 physical component summary and mental component summary scores were calculated for each group at baseline and at 2-year follow-up. A Fisher exact test was used to assess significance for categorical variables, and a t-test was used for continuous variables. VR-12 changes as small as 1 to 2 units have been found to be clinically and socially relevant. RESULTS: The baseline cohort data of 1,000,952 patients yielded 250,869 patients (25%) who reported the diagnosis of sciatica, compared with 750,083 patients (75%) without sciatica. Patients with a history of sciatica tended to be younger, less educated, and notably with more medical comorbidities. Physical component summary outcomes were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2-year follow-up. Mental component summary outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2-year follow-up. CONCLUSION: A large percentage of the US Medicare cohort suffers from symptomatic sciatica. Our study identified a 25% prevalence in the Medicare cohort. In addition, sciatica is associated with an increased incidence of comorbid medical conditions and poor health-related quality of life. LEVEL OF EVIDENCE: Level III STUDY DESIGN:: Observational-Cohort Study.

Irrigation water quality and the threat it poses to crop production: evaluating the status of the Crocodile (West) and Marico catchments, South Africa.

Ensuring food security is becoming increasingly difficult due to limited freshwater resources. Low-quality irrigation water also poses a severe threat to crop yield and quality. The aim of this study was to evaluate the water quality associated with the Crocodile (West) and Marico catchments, which represent one of South Africa's most developed regions. Sources of irrigation water include the hypertrophic Hartbeespoort Dam, as well as the heavily impacted Crocodile (West) River. Analysis of historical irrigation water quality data (from January 2005 to December 2015) revealed that the Hartbeespoort and Crocodile (West) irrigation schemes were exposed to calcium sulfate enrichment, likely as a result of extensive mining activities in the Bushveld Igneous Complex. Also, significant differences in water quality parameters occurred between these irrigation schemes and the reference system (Marico-Bosveld Irrigation Scheme), while important salt (chloride and sodium) and nutrient (inorganic nitrogen and orthophosphate (as phosphorus)) concentrations exceeded threshold values provided by irrigation water quality guidelines. The Hartbeespoort and Crocodile (West) irrigation schemes also presented distinctive temporal (long-term and seasonal) patterns in water quality. Seasonal variation in pH levels at the Hartbeespoort Irrigation Scheme is likely caused by excessive algae growth and cyanobacteria blooms (Mycrocystis sp.), which also pose an important threat to human and animal health. Despite mitigation efforts by government and other stakeholders, some of South Africa's major irrigation schemes remain highly impacted as a result of water quality deterioration.

Language medium and schizophrenic thought disorder.

Ten selected schizophrenic patients and 10 control subjects were assessed in their home language and in a second language for evidence of formal thought disorder. The performance of the schizophrenics was significantly poorer in their home language, while that of control subjects did not differ between the two languages. The results are compatible with Bannister's serial invalidation hypothesis of schizophrenic thought disorder. Of more immediate importance, they indicate that careful attention must be paid to the language used in assessing psychiatric patients in a multilingual society.