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We have conducted a study of the COVID-19 severity with the chest x-ray images, a private dataset collected from our collaborator St Bernards Medical Center. The dataset is comprised of chest x-ray images from 1,550 patients who were admitted to emergency room (ER) and were all tested positive for COVID-19. Our study is focused on the following two questions: (1) To predict patients hospital staying duration, based on the chest x-ray image which was taken when the patient was admitted to the ER. The length of stay ranged from zero hours to 95 days in the hospital and followed a power law distribution. Based on our testing results, it is hard for the prediction models to detect strong signal from the chest x-ray images. No model was able to perform better than a trivial most-frequent classifier. However, each model was able to outperform the most-frequent classifier when the data was split evenly into four categories. This would suggest that there is signal in the images, and the performance may be further improved by the addition of clinical features as well as increasing the training set. (2) To predict if a patient is COVID-19 positive or not with the chest x-ray image. We also tested the generalizability of training a prediction model on chest x-ray images from one hospital and then testing the model on images captures from other sites. With our private dataset and the COVIDx dataset, the prediction model can achieve a high accuracy of 95.9%. However, for our hold-one-out study of the generalizability of the models trained on chest x-rays, we found that the model performance suffers due to a significant reduction in training samples of any class.

A pandemic of respiratory illnesses from a novel coronavirus known as Sars-CoV-2 has swept across the globe since December of 2019. This is calling upon the research community including medical imaging to provide effective tools for use in combating this virus. Research in biomedical imaging of viral patients is already very active with machine learning models being created for diagnosing Sars-CoV-2 infections in patients using CT scans and chest x-rays. We aim to build upon this research. Here we used a transfer-learning approach to develop models capable of diagnosing COVID19 from chest x-ray. For this work we compiled a dataset of 112120 negative images from the Chest X-Ray 14 and 2725 positive images from public repositories. We tested multiple models, including logistic regression and random forest and XGBoost with and without principal components analysis, using five-fold cross-validation to evaluate recall, precision, and f1-score. These models were compared to a pre-trained deep-learning model for evaluating chest x-rays called COVID-Net. Our best model was XGBoost with principal components with a recall, precision, and f1-score of 0.692, 0.960, 0.804 respectively. This model greatly outperformed COVID-Net which scored 0.987, 0.025, 0.048. This model, with its high precision and reasonable sensitivity, would be most useful as “rule-in” test for COVID19. Though it outperforms some chemical assays in sensitivity, this model should be studied in patients who would not ordinarily receive a chest x-ray before being used for screening.CCS CONCEPTSLife and Medical Sciences • Machine Learning • Artificial IntelligenceReference formatJonathan Stubblefield, Jason Causey, Dakota Dale, Jake Qualls, Emily Bellis, Jennifer Fowler, Karl Walker and Xiuzhen Huang. 2022. COVID19 Diagnosis Using Chest X-Rays and Transfer Learning.

BACKGROUND Exception from informed consent (EFIC) enables the enrollment of research subjects with emergent conditions to clinical trials without prior consent. EFIC study approval requires community consultation and public disclosure. We hypothesized that the integration of social media with targeted emails and in-person outreach is an effective community consultation strategy. METHODS We utilized social media with targeted emails and in-person outreach for the community consultation of the ACCESS cardiac arrest trial. Study advertisements were disseminated using Facebook and Instagram, and targeted emails were sent to emergency medicine, prehospital, and cardiology providers. We also interviewed at-risk individuals with cardiac conditions, their caretakers, and patient advocacy groups. Participants were asked to complete a survey about their opinions about the study. RESULTS We collected 559 surveys over an 8-week period, and 70.5% of the surveys were obtained using social media. The median (IQR) age of survey respondents was 44 (33-57) years; 89.9% were White and 60.1% were women. A total of 91.3% believed ACCESS was an important study. Compared to the in-person group, more from social media (81.8% vs. 63.3%, p

Study objective Outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest depend on time to therapy initiation. We hypothesize that it would be feasible to select refractory out-of-hospital cardiac arrest patients for expedited transport based on real-time estimates of the 911 call to the emergency department (ED) arrival interval, and for emergency physicians to rapidly initiate ECPR in eligible patients. Methods In a 2-tiered emergency medical service with an ECPR-capable primary destination hospital, adults with refractory shockable or witnessed out-of-hospital cardiac arrest were randomized 4:1 to expedited transport or standard care if the predicted 911 call to ED arrival interval was less than or equal to 30 minutes. The primary outcomes were the proportion of subjects with 911 call to ED arrival less than or equal to 30 minutes and ED arrival to ECPR flow less than or equal to 30 minutes. Results Of 151 out-of-hospital cardiac arrest 911 calls, 15 subjects (10%) were enrolled. Five of 12 subjects randomized to expedited transport had an ED arrival time of less than or equal to 30 minutes (overall mean 32.5 minutes [SD 7.1]), and 5 were eligible for and treated with ECPR. Three of 5 ECPR-treated subjects had flow initiated in less than or equal to 30 minutes of ED arrival (overall mean 32.4 minutes [SD 10.9]). No subject in either group survived with a good neurologic outcome. Conclusion The Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest trial did not meet predefined feasibility outcomes for selecting out-of-hospital cardiac arrest patients for expedited transport and initiating ECPR in the ED. Additional research is needed to improve the accuracy of predicting the 911 call to ED arrival interval, optimize patient selection, and reduce the ED arrival to ECPR flow interval.

In statistical applications, two-way tables of numeric data, samples by variables, are often analyzed using principal component analysis (PCA), a special case of singular value decomposition (SVD)....

We present here the Arkansas AI-Campus solution method for the 2019 Kidney Tumor Segmentation Challenge (KiTS19). Our Arkansas AI-Campus team participated the KiTS19 Challenge for four months, from March to July of 2019. This paper provides a summary of our methods, training, testing and validation results for this grand challenge in biomedical imaging analysis. Our deep learning model is an ensemble of U-Net models developed after testing many model variations. Our model has consistent performance on the local test dataset and the final competition independent test dataset. The model achieved local test Dice scores of 0.949 for kidney and tumor segmentation, and 0.601 for tumor segmentation, and the final competition test earned Dice scores 0.9470 and 0.6099 respectively. The Arkansas AI-Campus team solution with a composite DICE score of 0.7784 has achieved a final ranking of top fifty worldwide, and top five among the United States teams in the KiTS19 Competition.

During the COVID-19 pandemic, biology educators were forced to think of ways to communicate with their students, engaging them in science and with the scientific community. For educators using course-based undergraduate research experiences (CUREs), the challenge to have students perform real science, analyze their work, and present their results to a larger scientific audience was difficult as the world moved online. Many instructors were able to adapt CUREs utilizing online data analysis and virtual meeting software for class discussions and synchronous learning. However, interaction with the larger scientific community, an integral component of making science relevant for students and allowing them to network with other young scientists and experts in their fields, was still missing. Even before COVID-19, a subset of students would travel to regional or national meetings to present their work, but most did not have these opportunities. With over 300 million active users, Twitter provided a unique platform for students to present their work to a large and varied audience. The Cell Biology Education Consortium hosted an innovative scientific poster session entirely on Twitter to engage undergraduate researchers with one another and with the much broader community. The format for posting on this popular social media platform challenged students to simplify their science and make their points using only a few words and slides. Nineteen institutions and over one hundred students participated in this event. Even though these practices emerged as a necessity during the COVID-19 pandemic, the Twitter presentation strategy shared in this paper can be used widely.

Recreational drone use has increased in popularity over the past decade. Public lands offer additional opportunities for drone use as unique monitoring tools as well as videography to enhance visitor experiences. However, there are many concerns regarding privacy and impacts to resources and experiences. While drone technology has advanced rapidly, research on the challenges, opportunities, and management strategies have been limited leading to inconsistent policies across diverse public land settings. We propose a research agenda to guide future research and management related to drone use. There are social, ecological, and managerial considerations that are interrelated and operate across scales from the local sites to national policy. These scales are disjointed, creating challenges for policy development with a lack of research to inform decisions. It is our hope that this study stimulates discussion that is timely and relevant and can inform multi-scalar and multidisciplinary research on recreational drone use on public lands. Subscribe to JPRA

One of the challenges with urgent evaluation of patients with acute respiratory distress syndrome (ARDS) in the emergency room (ER) is distinguishing between cardiac vs infectious etiologies for their pulmonary findings. We conducted a retrospective study with the collected data of 171 ER patients. ER patient classification for cardiac and infection causes was evaluated with clinical data and chest X-ray image data. We show that a deep-learning model trained with an external image data set can be used to extract image features and improve the classification accuracy of a data set that does not contain enough image data to train a deep-learning model. An analysis of clinical feature importance was performed to identify the most important clinical features for ER patient classification. The current model is publicly available with an interface at the web link: http://nbttranslationalresearch.org/.

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) is promising but is unproven, and outcomes are strongly dependent on time to initiation of therapy. Expedited transport may facilitate opportunities for ECPR in clinical practice and future trials. Hypotheses: We hypothesized that a real-time dispatch-based computer algorithm could select refractory OHCA patients who could be reliably transported to the emergency department (ED) within 30 min of the 911 call, and that Emergency Medicine physicians could initiate ECPR in eligible patients within 30 min of ED arrival. Methods: In a 2-tiered EMS system serving a US city of 100k in 29 square miles with an ECPR capable primary destination hospital, adults with refractory shockable or witnessed OHCA were randomized 4:1 to expedited transport (ET) or standard prehospital care (SC) if the predicted 911 to ED arrival time was Results: Out of 156 cardiac arrest runs, 15 participants (10%) were randomized prior to ending the trial for slow accrual. Five of 12 patients randomized to expedited transport had an ED arrival time of Conclusions: EROCA demonstrated a functional model for selecting patients with refractory OHCA for ET in an ECPR capable system but did not meet predefined time-interval targets. These results provide important insight into the feasibility of ECPR clinical trials and clinical practice based on selected target intervals.

One of the challenges with urgent evaluation of patients with acute respiratory distress syndrome (ARDS) in the emergency room (ER) is distinguishing between cardiac vs infectious etiologies for their pulmonary findings. We evaluated ER patient classification for cardiac and infection causes with clinical data and chest X-ray image data. We show that a deep-learning model trained with an external image data set can be used to extract image features and improve the classification accuracy of a data set that does not contain enough image data to train a deep-learning model. We also conducted clinical feature importance analysis and identified the most important clinical features for ER patient classification. This model can be upgraded to include a SARS-CoV-2 specific classification with COVID-19 patients data. The current model is publicly available with an interface at the web link: http://nbttranslationalresearch.org/.Data statementThe clinical data and chest x-ray image data for this study were collected and prepared by the residents and researchers of the Joint Translational Research Lab of Arkansas State University (A-State) and St. Bernards Medical Center (SBMC) Internal Medicine Residency Program. As data collection is on-going for the project stage-II of clinical testing, raw data is not currently available for data sharing to the public.EthicsThis study was approved by the St. Bernards Medical Center’s Institutional Review Board (IRB).

Introduction: Exception from informed consent (EFIC) enables the enrollment of subjects with emergent conditions for clinical trials without prior consent. All EFIC studies are required to include community consultation (CC). However, CC implementation is often challenged by significant cost and scarce community engagement. Hypothesis: We hypothesize that the utilization of social media, targeted emails, and interviews of at-risk individuals and their caretakers can lead to more effective EFIC CC. Methods: We utilized social media and targeted emails/interviews for the EFIC CC of the ACCESS to the Cardiac Catheterization Laboratory in Patients Without ST-Segment Elevation Myocardial Infarction Resuscitated From Out-of-hospital Ventricular Fibrillation Cardiac Arrest Trial. We disseminated study advertisements with survey links and opt-out option using Facebook/Instagram to our communities and targeted emails to prehospital and cardiology providers. We also interviewed at-risk individuals with cardiac conditions, their caretakers, and patient advocacy groups. Between-group comparisons of proportions were tested using modified chi-squared tests for small sample size. Results: We collected 559 fully or partially completed surveys over an eight-week period. The majority of the surveys (70.5%) were obtained using social media. The mean age was 45 years; 90% were white and 61% were female. Overall, 91.3% believed ACCESS is an important study. The interview group had significantly more loved ones with cardiac arrest than the social media (50% vs 36.7%, p < 0.05) or targeted email (50% vs 23.6%, p < 0.005) group. Compared to the interview group, more from social media (81.8% vs 63.3%, p < 0.05) and targeted email (77.4% vs 63.3, p < 0.05) groups said they would include their loved ones in the study. More from the interview group believed that their opinion would be considered seriously compared to the social media (75.9% vs 62.6%, p < 0.05) and targeted email (75.9% vs 54.5%, p < 0.05) groups. No one opted out from the study. Conclusions: The integration of social media with targeted emails and interviews is an effective approach for EFIC CC. Future work is necessary to determine the perception and best utilization of these strategies for EFIC studies.

Regular physical activity (PA) is a health promoting behavior that transcends species. The collective evidence of a positive relationship between PA and health in both people and animals suggests that implementation of outdoor, dog-associated activities to increase PA may synergistically enhance both human and dog health. A systematic literature review was performed to identify research investigating objective, quantitative health outcomes in both dogs and people exercising together. Within the confines of the search, only 2 studies fulfilled the criteria for complete review. One study was administered through a veterinary clinic and another through a human health care provider. Both studies focused on obesity treatment, either for the dog or for both the dog and the owner. Collectively this work demonstrates the feasibility of simultaneously promoting health in both groups through PA; however there are limitations to the generalizability of the findings. Additional research is needed to further investigate the feasibility and effectiveness of PA promotion in primary care veterinary clinics as well as the use of animal-assisted PA promotion as a preventative, not just therapeutic, tool. As diseases that can be prevented, at least in part, by regular PA are now the leading causes of morbidity and mortality in developed countries, veterinarians have the potential to significantly impact not only the health of their patients, but also that of the public.

Internal gravity waves are oscillations of a fluid parcel about an equilibrium level generated by a buoyancy force when the stability of the fluid medium is disrupted. Such a disturbance occurs from the obstruction of solar irradiance during a solar eclipse and may generate a gravity wave that can be detected using radiosondes. In this study, surface and upper air measurements made from a series of radiosondes launched throughout the duration of the August 21, 2017 total solar eclipse over the US as part of the National Eclipse Ballooning Project are examined for eclipse-induced gravity-wave activity. Preliminary results of radiosonde wind data collected throughout the eclipse from multiple sites within the path of totality in Wyoming reveal wave-like structures with intrinsic angular frequencies ranging 3.3 – 4.2 x 10-2 s-1 at altitudes within 18-20 km. The results of the wind data analysis presented here can be compared to results produced by wavelet analysis to either confirm or deny the generation of an eclipse-induced gravity-wave. Identifying the wave’s structure would aid in wave prediction software to improve weather forecast models.

To improve survival of patients resuscitated from out of hospital cardiac arrest (OCHA), data is needed to assess and improve inpatient post-resuscitation care. Our objective was to apply probabilistic linkage methodology to link EMS and inpatient databases and evaluate whether it may be used to describe post-arrest care in Michigan.We performed a retrospective study to describe post-cardiac arrest care in adult OHCA patients who were transported to Michigan hospitals from July 1, 2010, to June 30, 2013. Using probabilistic linkage methodology we linked two databases, the Michigan EMS Information System (MI_EMSIS) and the Michigan Inpatient Database (MIDB), which describes inpatient care and outcome of all admissions. Rates of case incidence and survival were compared to published literature. We compared the linked dataset to existing cardiac arrest databases from three counties to evaluate the quality of this linkage.Multiple iterations of match strategies were used to create a linked EMS-inpatient dataset. There were 12,838 MI_EMSIS cardiac arrest records of which 1,977 were matched with MIDB records, identifying them as surviving to hospital admission. Of these 590 (30.0%) survived to hospital discharge. The annual survival incidence/100,000 population to admission was 6.93/100,000 and survival incidence to discharge was 2.1/100,000. The matched dataset was compared to county databases identified a limited sensitivity [48.2%, 95% CI 42.1%-55.3%)] and positive predictive value [64.4%, 95% CI 56.8%-71.3%)].Use of the MI_EMSISEMS database and the Michigan Inpatient database was feasible and produced rates of cardiac arrest admission and survival rates similar to published literature. This process yielded a limited match compared to existing county cardiac arrest databases. We conclude that such a linked dataset is useful for descriptive purposes but not as a population based dataset to evaluate statewide post-cardiac arrest care.

Objectives The hypothesis was that a reminder about recommended primary care physician (PCP) follow-up, sent via e-mail to patients discharged from the emergency department (ED), would increase the proportion of patients who followed up with their PCPs within the recommended time frame. Patient receptiveness to e-mail follow-up reminders was also assessed. Methods This was a mixed methods clinical intervention study with subjects randomized either to receive the usual care discharge instructions only or to also receive a reminder e-mail message the day after the ED visit. The reminder e-mail contained the subject's PCP's name and address and the recommended PCP follow-up time interval. A blinded review of outpatient PCP medical records was conducted to determine whether and when follow-up occurred. Researchers attempted to contact patients with a telephone survey 2 weeks after their ED visits. The primary outcomes between groups were compared using chi-square tests and relative risks (RRs) with 95% confidence intervals (CIs). Results Thirty-three percent of the intervention group and 32% of the control group followed-up as recommended (RR = 1.04, 95% CI = 0.81 to 1.33); 52% of the intervention group and 48% of the control group followed-up within 10 days of the recommended time (RR = 1.08, 95% CI = 0.91 to 1.29). The 334 patients (57%) successfully contacted via telephone demonstrated a high interest in receiving future e-mail reminders (75%), with the group that received e-mail reminders more likely to want one in the future than those who did not receive e-mail reminders (82.5% vs. 69.76%; p = 0.04). Conclusions E-mail reminders sent after ED visits did not improve patients' adherence to the recommended timing of primary care follow-up contained in discharge instructions. Subjects in both the control and the intervention groups favorably viewed the concept of e-mail reminders, suggesting that the value of e-mail reminders after ED discharge may be in areas such as patient satisfaction that were not specifically targeted for measurement in this study.

Radiosonde-collected data are of vital importance to a wide variety of studies that aim at understanding the interaction between land surface and the atmosphere, among others. However, atmospheric measurements in developing countries, some of which encompass areas critical to the regulation of global climate, are sparse due to the lack of funding allocated toward collecting such data, and therefore fail to meet the standards set by the World Meteorological Organization. We review current radiosonde technologies and an alternative that aims at lowering sounding costs by recovering the sondes: the glidersonde. Two major issues currently hamper future development and commercialization of this technology: 1) how to have reusable radiosondes while keeping the market viable for the sonde manufacturers, and 2) the need for consistent and effective governmental aviation regulations for developing and flying glidersondes. We conclude this review with an alternative consideration as an incentive for cooperation in ...

Objective: Radial artery harvesting for coronary artery bypass may lead to digit ischemia if collateral hand circulation is inadequate. The modified Allen's test is the most common preoperative screening test used. Unfortunately, this test has high false-positive and false-negative rates. The purpose of this study was to compare the results of a modified Allen's test with digit pressure change during radial artery compression for assessing collateral circulation before radial artery harvest. Methods: One hundred twenty-nine consecutive patients were studied before coronary artery bypass operations. A modified Allen's test was performed with Doppler ultrasound to assess blood flow in the superficial palmar arch before and during radial artery compression. A decreased audible Doppler signal after radial artery compression was considered a positive modified Allen's test. First and second digit pressures were measured before and during radial artery compression. A decrease in digit pressure of 40 mm Hg or more (digit ΔP) with radial artery compression was considered positive. Results: Seven of 14 dominant extremities (50%) and 8 of the 16 nondominant extremities (50%) with a positive modified Allen's test had a digit ΔP of less than 40 mm Hg (false positive). Sixteen of 115 dominant extremities (14%) and 5 of 112 nondominant extremities (4%) with a negative Allen's test had a digit ΔP of 40 mm Hg or more with radial artery compression (false negative). Conclusion: Use of the modified Allen's test for screening before radial artery harvest may unnecessarily exclude some patients from use of this conduit and may also place a number of patients at risk for digit ischemia from such harvest. Direct digit pressure measurement is a simple, objective method that may more precisely select patients for radial artery harvest. Additional studies are needed to define objective digital pressure criteria that will accurately predict patients at risk for hand ischemia after radial harvest. (J Thorac Cardiovasc Surg 1999;117:261-6)

Background: The increased use of the radial artery for coronary artery bypass conduits has heightened the awareness of potential resultant hand ischemia. The Allen test and subsequent modifications have been used to evaluate the patency of the superficial palmar arch (SPA). The purpose of this study was to determine if changes in blood flow patterns of the SPA assessed by the modified Allen test parallel changes in blood pressures of the first and second digits following radial artery occlusion. Methods: Continuous-wave Doppler ultrasound and photoplethysmography (PPG) were used to evaluate blood flow in the SPA and first and second digits, respectively, before and after manual occlusion of the radial artery in 60 extremities. A second continuouswave Doppler probe was used to ensure complete occlusion of the radial artery. Digit skin temperature was controlled between 36° and 37.5°0. A reduction of >20 mmHg in blood pressure was arbitrarily chosen to reflect a clinically significant change in digit arterial pressure. Results: Six of the 60 extremities (10%) studied showed a decrease in the audible Doppler signal over the SPA following radial artery occlusion. Reduction in digit arterial pressure following radial artery occlusion occurred in 13 of 60 extremities (21.7%). Digit arterial pressure reductions ranged from 20 to 58 mmHg (mean ±SD, 35.2 ±12.8 mmHg), demonstrating a 40% decrease in digital pressure. Changes in SPA flow did not parallel digital pressure changes following occlusion of the radial artery. Conclusion: Continuous-wave Doppler ultrasound of the SPA following radial artery compression alone does not accurately predict digit ischemia. Digit arterial pressure measurement of the first and second digits of upper extremities offers a relatively simple and objective method for evaluation of potential ischemic complications following radial artery harvest. This finding is important because many physicians only use a modified Allen test with radial artery compression to assess potential digit ischemia.

PURPOSE: Antibiotics suppress normal gut flora, allowing overgrowth of acquired or nativeClostridium difficile, with release of toxins that cause mucosal inflammation. Oral metronidazole is used to treat antibiotic-associated colitis (pseudomembranous colitis). This study was designed to determine whether oral metronidazole, as part of preoperative bowel preparation, prevents or decreases incidence of antibiotic-associated colitis after elective colonic and rectal procedures. METHODS: Eighty-two patients (40 men) were prospectively, randomly assigned to receive one of two oral antibiotic regimens before colorectal surgery. All patients underwent mechanical bowel preparation with polyethylene glycol-electrolyte lavage solution before administration of oral antibiotics. Group 1 (n=42) patients received three doses (1 g/dose) of neomycin and erythromycin. Group 2 (n=40) patients received three doses (1 g/dose) of neomycin and metronidazole. Both groups received one preoperative and three postoperative doses of intravenous cefotetan (2 g/dose). Both groups had stool samples tested forC. difficile toxin in the preoperative and postoperative periods by enzyme-linked immunoabsorbent assay or by tissue culture cytotoxicity. Patients with preoperative stool studies positive forC. difficile were excluded from the study. RESULTS: Treatment groups were not different for age, gender, or surgical procedure. Mean age ±1 standard deviation was 67.6±13.6 (range, 34–94) years in Group 1 and 62.1±13.5 (range, 35–84) years in Group 2 (P=0.069). Mean length of hospital stay ±1 standard deviation was 9.76±4.9 (range, 4–28) days for Group 1 and 8.05±2.6 (range, 3–14) days for Group 2 (P=0.053). Five patients in Group 1 (neomycin and erythromycin) and one patient in Group 2 (neomycin and metronidazole) had positive stool studies forC. difficile. Relative risk of colonization withC. difficile in Group 1 was 4.76 times that in Group 2 (95 percent confidence interval, 0.581, 39). This difference was not statistically significant (P=0.202). There were no significant differences inC. difficile colonization rates with respect to age, length of stay, or gender. CONCLUSIONS: This study suggests that there may be a clinical association between use of metronidazole preoperatively and inhibition of intestinal colonization byC. difficile in this patient population undergoing colonic and rectal surgery.

Objectives We developed a communication instrument to be used in the Emergency Department (ED) and hypothesized that use of this guide would increase patient comprehension of and satisfaction with care. Methods This multi-site trial enrolled 643 patients in treatment and control groups. Comprehension of care was assessed by chart review and satisfaction measured via validated survey. Results Use of the instrument was not associated with improvements in patient knowledge about their care, with a mean of 4.6 (95% CI: 4.8–5.8) comprehension defects in the control group and 4.4 (95% CI: 3.9–4.9) in the treatment group. There was no significant effect on patient satisfaction 76.4% versus 76.9%, p =0.34. Elderly patients in both groups were found to have 1.1 ( p Conclusion Patients frequently misunderstand medical care in the ED. Comprehension decreases with increasing age. An isolated communication instrument does not improve satisfaction with or understanding of the care received. Practice implications Providing a structured place for providers and patients to record details of care does not seem to improve satisfaction with or comprehension of care. Interventions that focus on communication skills and face time with patients may prove more effective.

When female three-spined sticklebacks, Gasterosteus aculeatus, were presented simultaneously two video playbacks of a courting male, one playback displayed in colour and the other in greytone, the female approached and attempted to follow both displays. Females that responded strongly to playback of the male clearly preferred the coloured display, whereas those that responded less showed no consistent preference for coloured or greytoned displays. Females showed some approach to playback of a non-reproductive female but did not prefer the coloured over the greytoned one. These results suggest that the female's sexual motivation influences the mechanism(s) mediating her attraction to nuptially coloured males. Although highly motivated animals may typically show reduced selectivity in successive choice situations, they appeared to be more selective in the simultaneous choice situation studied here, perhaps because they attend more to male nuptial coloration, or because they become less fearful of brightly coloured males. These results demonstrate the effectiveness of video playback for investigating the role of visual cues in stickleback behaviour. They also emphasize the value of considering motivational factors in studies on sexual selection and, especially, when designing or interpreting experiments on mate choice.

Background Emergency department (ED) communication has been demonstrated as requiring improvement and ED patients have repeatedly demonstrated poor comprehension of the care they receive. Through patient focus groups, the authors developed a novel tool designed to improve communication and patient comprehension. Study design This is a prospective, randomised controlled clinical trial to test the efficacy of a novel, patient-centred communication tool. Patients in a small community hospital ED were randomised to receive the instrument, which was utilised by the entire ED care team and served as a checklist or guide to the patients9 ED stay. At the end of the ED stay, patients completed a survey of their comprehension of the care and a communication assessment tool-team survey (a validated instrument to assess satisfaction with communication). Three blinded chart reviewers scored patients9 comprehension of their ED care as concordant, partially concordant or discordant with charted care. The authors tested whether there was a difference in satisfaction using a two-sample t test and a difference in comprehension using ordinal logistic regression analysis. Results 146 patients were enrolled in the study with 72 randomised to receive the communication instrument. There was no significant difference between groups in comprehension (OR=0.65, 95% CI 0.34 to 1.23, p=0.18) or communication assessment tool-team scores (difference=0.2, 95% CI: −3.4 to 3.8, p=0.91). Conclusions Using their novel communication tool, the authors were not able to show a statistically significant improvement in either comprehension or satisfaction, though a tendency towards improved comprehension was seen.

This thesis explores how to design an addition to a modern building that makes the building users cognizant of the layers of history while simultaneously creating spaces that respond to the needs of the occupants today. The existing building, the Washington D.C. Central Library, designed by Mies van der Rohe, is conserved and rehabilitated maintaining the library function and new space is created for the Foundation for the Study of Social Media. The addition and the surgical rehabilitation of the existing are informed by the design concepts and details of Mies van der Rohe as well as the theories of Carlo Scarpa. The project evolves through a detail outward design approach in which material and spatial relationships at critical joints are first determined and then used to inform the design of the whole. Master of Architecture

Purpose Research is educationally important for surgical residents. However, little information exists regarding effective methods for teaching residents scientific methodology in a community hospital. This effort describes an effective program conducted in a community hospital for enhancing scientific opportunities of surgical residents. Methods A strong infrastructure that supports research is necessary. Dedicated nonsalaried teaching faculty serve as mentors and co-investigators. Opportunities to engage in basic research are made available in off-campus basic science laboratories. Results Research productivity has been prolific, as demonstrated by numerous publications. Residents interested in subspeciality training have been able to conduct research that has made them competitive for fellowships and a wider range of practice choices. Conclusion Rigorous research can be effectively taught in a community hospital, provided adequate educational and funding support is provided and faculty actively mentor residents. Having research capabilities provides added incentive for better-qualified medical students to apply to a surgical residency position in a community hospital. Research productivity also enhances the ability to better recruit new faculty.

Radial artery harvesting for coronary revascularization may result in digit ischemia if collateral circulation is inadequate. The purpose of this study was to compare changes in ulnar artery flow velocity during radial artery compression (RAC) with changes in first- and second-digit pressures during RAC, a previously validated predictor of digital ischemia. Photoplethysmography was used to measure first- and second-digit arterial pressures before and during RAC on 80 extremities. Color flow duplex imaging was used to measure distal ulnar artery peak systolic velocity before and during RAC. Seventy-eight of eighty extremities had a slight increase in ulnar artery velocity with RAC. There was no correlation between ulnar artery velocity changes and digit pressure changes. Measurement of ulnar artery velocity during RAC is not a useful predictor of digit pressure changes. Measurement of segmental upper extremity pressures with first- and second-digit pressure measurement during radial artery compression should remain the preferred preoperative screening tool for radial artery harvest prior to CABG.

Abstract 3221 Children with sickle cell disease (SCD) are at high risk for thrombotic stroke. Transcranial doppler ultrasound (TCD) is utilized to predict children at highest risk. Anemia and and vessel occlusion are assocated with elevated TCD velocities and risk of stroke. There is increasing evidence that a prothrombotic state contributes to the complications of SCD including stroke. We hypothesized that increased thrombin generation and platelet activation are associated with increased TCD velocities. We conducted a cross-sectional cohort study of children with SCD at Duke University Medical Center. Children had been clinically well for at least 2 weeks, had not been transfused for at least 3 months, and had TCD performed at study enrollment (n= 28) or within the prior 6 months (n=7). TCD time-averaged mean velocities (TAMV) were calculated for each patient and used for analysis. Blood was collected at the time of study entry per study protocol. Thrombin generation was measured utilizing: D-dimer; thrombin antithrombin (TAT); and calibrated automated thrombography (CAT) which evaluates phases of thrombin production including lag phase, time to peak thrombin, endogenous thrombin potential (ETP), and peak thrombin. Platelet activation was assessed by measurement of soluble glycoprotein V (sGPV). Clinical data were abstracted from the medical record including confirmation of SS genotype, use of hydroxyurea, prior sickle cell-related clinical events, and hematological data including hemoglobin, platelets and white blood cell count. SCD severity scores were calculated to classify patients as either high risk or low/moderate risk (van den Tweel et al, 2010). Linear regression analyses were conducted to assess correlation. Children with high risk severity scores were compared to children with low/moderate risk severity scores. Statistical analysis was performed using Graphpad 5.0; p Disclosures: Shah: Adventrx: Consultancy; Eisai: Research Funding. Off Label Use: Hydroxyurea for use in pediatric sickle cell disease. Ortel:Eisai: Research Funding; Glaxo SmithKline: Research Funding; Pfizer: Research Funding; Instrumentation Laboratory, Inc: Consultancy, Research Funding; Boehringer Ingelheim: Consultancy.