Source:https://www.pennmedicine.org/news/news-releases/2018/november/yelp-reviews-reveal-strengths-and-weaknesses-of-emergency-departments-and-urgent-care-clinics Reviewed by James Ives, M.Psych. (Editor)Nov 12 2018Yelp reviews reveal that emergency departments are viewed as being higher quality but lacking in service as compared to urgent care centers, which patients rate the opposite, according to a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania. The study results, published this month in the Annals of Emergency Medicine, provide a unique opportunity for researchers and clinicians to learn from online reviews, which provide a raw narrative from consumers.”Today’s world is very digital, and it’s very common for consumers to rate a restaurant, hotel or service online, a practice that is spilling over into health care,” said the study’s lead author, Anish Agarwal, MD, a National Clinician Scholars fellow and Emergency Medicine physician at Penn Medicine. “As an emergency department physician, patients often tell me that the internet is the first place they go for information about medical conditions and to research providers. Health systems and clinicians can learn a lot about the communities they treat and how people experience the services they provide by looking to online ratings and reviews.”In this new study, researchers, with the help of an automated system, analyzed high (five-star) and low (one-star) Yelp reviews for both emergency departments and urgent care centers, two venues that patients can select from when in need of acute care.Researchers identified key themes in the five-star reviews of emergency departments, including bedside manner, treatment of family members, and access to care on nights and weekends. Urgent care centers were unique in receiving five-star reviews more often for factors including ease of refilling prescriptions and being positively recommended by others.On the other side, emergency departments received negative remarks for speed of care, while urgent care centers received one-star reviews as a result of poor reception experiences and patients lacking confidence in the care received.”We are seeing more and more that patients are sharing their experiences online, and they’re looking to social media platforms and online communities to help inform their decision-making,” said Kevin B. Mahoney, executive vice president and chief administrative officer of the University of Pennsylvania Health System. “Within these review and rating websites lies a trove of decision-making data that we can and should be culling through to help inform how care is delivered, and what matters most to our patients in emergency situations.”Related StoriesIt is okay for women with lupus to get pregnant with proper care, says new studyAMSBIO offers new, best-in-class CAR-T cell range for research and immunotherapyOlympus Europe and Cytosurge join hands to accelerate drug development, single cell researchUrgent care centers have proliferated widely across the country in the past 15 years. Between 2007 and 2016, visits increased by more than 1,700 percent. But while emergency departments have established surveys for patients and their families to report their experiences, there is not a clear equivalent for gathering direct feedback from patients who visit urgent care centers.The study’s senior author, Raina Merchant, MD, director of the Penn Medicine Center for Digital Health and an associate professor in Emergency Medicine, believes Yelp reviews could fill a knowledge gap.”Online reviews provide a rapid way of taking the pulse of how this acute care market is emerging and what consumers look for in these settings” said Merchant. “These platforms can also help us identify new focus areas, in an effort to provide better, more efficient care to patients based on their expressed needs.”The researchers analyzed more than 100,000 Yelp reviews, posted between 2005 and 2017–in the midst of the urgent care boom–tied to 1,566 emergency departments and 5,601 from urgent care centers. During the study period, an average of one new review for an emergency department or an urgent care center appeared every hour of every day.The reviews fell largely on one end of the spectrum or the other: five stars or one star. Roughly 47 percent of emergency department and 30 percent of urgent care center reviews fell in the one-star category. The disproportionate amount of negative reviews for acute care facilities, compared to other entities reviewed online, like hotels or restaurants, could be a result of what is at stake for the consumer.”If a restaurant provides you with a quick meal exactly as advertised, they meet your expectations,” Merchant said. “With healthcare, things are different. People are often critically ill, the outcomes are uncertain, and the wait can be long–which are all things that sometimes can’t be controlled.”The research team found that each type of facility received similar five-star reviews for comfort, cleanliness of facilities, pediatric care, and professionalism. One-star reviews for poor phone experiences, long wait times, billing difficulties, and pain management were tied to both emergency departments and urgent care centers.Moving forward, the researchers hope to find more nontraditional sources to provide clues about patient experiences and use them to enhance care quality.
Source:https://wyss.harvard.edu/predicting-leaky-heart-valves-with-3d-printing/ Reviewed by James Ives, M.Psych. (Editor)Dec 11 2018New integrated workflow improves valve sizing accuracy during aortic valve replacement proceduresMore than one in eight people aged 75 and older in the United States develop moderate-to-severe blockage of the aortic valve in their hearts, usually caused by calcified deposits that build up on the valve’s leaflets and prevent them from fully opening and closing. Many of these older patients are not healthy enough to undergo open heart surgeries; instead, they have artificial valves implanted into their hearts using a procedure called transcatheter aortic valve replacement (TAVR), which deploys the valve via a catheter inserted into the aorta. There are challenges with this procedure, however, including the need to choose the perfect-sized heart valve without ever actually looking at the patient’s heart: too small, and the valve can dislodge or leak around the edges; too large, and the valve can rip through the heart, carrying a risk of death. Like Goldilocks, cardiologists are looking for a TAVR valve size that is “just right”.Researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University have created a novel 3D printing workflow that allows cardiologists to evaluate how different valve sizes will interact with each patient’s unique anatomy, before the medical procedure is actually performed. This protocol uses CT scan data to produce physical models of individual patients’ aortic valves, in addition to a “sizer” device to determine the perfect replacement valve size. The work was performed in collaboration with researchers and physicians from Brigham and Women’s Hospital, The University of Washington, Massachusetts General Hospital, and the Max Planck Institute of Colloids and Interfaces, and is published in the Journal of Cardiovascular Computed Tomography.”If you buy a pair of shoes online without trying them on first, there’s a good chance they’re not going to fit properly. Sizing replacement TAVR valves poses a similar problem, in that doctors don’t get the opportunity to evaluate how a specific valve size will fit with a patient’s anatomy before surgery,” said James Weaver, Ph.D., a Senior Research Scientist at the Wyss Institute who is a corresponding author of the paper. “Our integrative 3D printing and valve sizing system provides a customized report of every patient’s unique aortic valve shape, removing a lot of the guesswork and helping each patient receive a more accurately sized valve.”When a patient needs a replacement heart valve, they frequently get a CT scan, which takes a series of X ray images of the heart to create a 3D reconstruction of its internal anatomy. While the outer wall of the aorta and any associated calcified deposits are easily seen on a CT scan, the delicate “leaflets” of tissue that open and close the valve are often too thin to show up well. “After a 3D reconstruction of the heart anatomy is performed, it often looks like the calcified deposits are simply floating around inside the valve, providing little or no insight as to how a deployed TAVR valve would interact with them,” Weaver explained.To solve that problem, Ahmed Hosny, who was a Research Fellow at the Wyss Institute at the time, created a software program that uses parametric modeling to generate virtual 3D models of the leaflets using seven coordinates on each patient’s valve that are visible on CT scans. The digital leaflet models were then merged with the CT data and adjusted so that they fit into the valve correctly. The resulting model, which incorporates the leaflets and their associated calcified deposits, was then 3D printed into a physical multi-material model.Related StoriesCancer incidence among children and young adults with congenital heart diseaseSmoking triples the risk of death from cardiovascular diseaseTeam approach to care increases likelihood of surviving refractory cardiogenic shockThe team also 3D printed a custom “sizer” device that fits inside the 3D-printed valve model and expands and contracts to determine what size artificial valve would best fit each patient. They then wrapped the sizer with a thin layer of pressure-sensing film to map the pressure between the sizer and the 3D-printed valves and their associated calcified deposits, while gradually expanding the sizer.”We discovered that the size and the location of the calcified deposits on the leaflets have a big impact on how well an artificial valve will fit into a calcified one,” said Hosny, who is currently at the Dana-Farber Cancer Institute. “Sometimes, there was just no way a TAVR valve would fully seal a calcified valve, and those patients could actually be better off getting open-heart surgery to obtain a better-fitting result.”In addition, the multi-material design of the 3D-printed valve models, which incorporate flexible leaflets and rigid calcified deposits into a fully integrated shape, could much more accurately mimic the behavior of real heart valves during artificial valve deployment, as well as provide haptic feedback as the sizer is expanded.The team tested their system against data from 30 patients who had already undergone TAVR procedures, 15 of whom had developed leaks from valves that were too small. The researchers predicted, based on how well the sizer fit into the 3D printed models of their aortic valves, what size valve each patient should have received, and whether they would experience leaks after the procedure. The system was able to successfully predict leak outcome in 60-73% of the patients (depending on the type of valve the patient had received), and determined that 60% of the patients had received the appropriate size of valve.”Being able to identify intermediate- and low-risk patients whose heart valve anatomy gives them a higher probability of complications from TAVR is critical, and we’ve never had a non-invasive way to accurately determine that before,” said co-author Beth Ripley, M.D., Ph.D, an Assistant Professor in the Department of Radiology at the University of Washington who was a Cardiovascular Imaging Fellow at Brigham and Women’s Hospital when the study was done. “Those patients might be better served by surgery, as the risks of an imperfect TAVR result might outweigh its benefits.” Additionally, being able to physically simulate the procedure might inform future iterations of valve designs and deployment approaches.The team has made their leaflet modeling software and 3D printing protocol freely available online for researchers or clinicians who wish to use them. They hope their project will serve as a springboard for evolvable biomedical design that keeps pace with the market’s state of the art.”At the core of the personalized medicine challenge is the realization that one medical treatment will not serve all patients equally well, and that therapies should be tailored to the individual,” said Wyss Institute Founding Director Donald Ingber, M.D., Ph.D., who is also the Judah Folkman Professor of Vascular Biology at Harvard Medical School and the Vascular Biology Program at Boston Children’s Hospital, as well as Professor of Bioengineering at Harvard’s School of Engineering and Applied Sciences. “This principle applies to medical devices as well as drugs, and it is exciting to see how our community is innovating in this space and attempting to translate new personalized approaches from the lab and into the clinic.” read more
Source:https://news.rub.de/english/press-releases/2018-12-19-neuroscience-how-brain-reacts-loss-vision Reviewed by Alina Shrourou, B.Sc. (Editor)Dec 19 2018Going blind affects all senses, and disrupts memory abilityIf mice lose their vision immediately after birth due to a genetic defect, this has a considerable impact, both on the organization of the cerebral cortex and on memory ability. This is the conclusion drawn by researchers at Ruhr-Universität Bochum in a study published online in the journal Cerebral Cortex on 7 December 2018. They demonstrated that, in the months after blindness emerged, the density of neurotransmitter receptors that regulate excitation balance and are required for memory encoding was altered in all areas of the cortex that process sensory information. Furthermore, the hippocampus, a brain region that plays a crucial role in memory processes, was profoundly affected.Mirko Feldmann, Daniela Beckmann, Professor Ulf Eysel and Professor Denise Manahan-Vaughan from the Department of Neurophysiology conducted the study.Other senses sharpen after loss of visionFollowing the loss of vision, other senses become gradually more sensitive: tactile and hearing acuity and one’s sense of smell all improve, enabling a blind individual to use these senses to navigate accurately through the environment, despite a lack of visual input. But this process takes time and practice. The associated changes in the brain are facilitated by synaptic plasticity, a process that enables experience-dependent adaptation, learning and memory. One clue as to whether reorganizational adaptation is taking place in the brain is obtained by analyzing the density and distribution of neurotransmitters that are crucial for synaptic plasticity.Adaptation requires major effort from the brainRelated StoriesPosterior parietal cortex plays crucial role in making decisions, research showsWearing a hearing aid may mitigate dementia riskDon’t Miss the Blood-Brain Barrier Drug Delivery (B3DD) Summit this AugustThe researchers from Bochum studied what happens in the brain after loss of vision in mice. They examined the density of neurotransmitter receptors after the emergence of blindness and compared the results with the brains of healthy mice. In addition, they tested how well the blind mice performed in spatial recognition tests, in order to examine the animals’ memory.Before any changes had developed in the sensory cortices, the researchers observed that loss of vision was first followed by changes in the density of neurotransmitter receptors and impairments of synaptic plasticity in the hippocampus. In subsequent months, hippocampal plasticity became more impaired and spatial memory was affected. During this time the density of neurotransmitter receptors also changed in the visual cortex, as well as in other cortical areas that process other sensory information.”After blindness occurs, the brain tries to compensate for the loss by ramping up its sensitivity to the missing visual signals,” explains Denise Manahan-Vaughan, who led the study. When this fails to work, the other sensory modalities begin to adapt and increase their acuities. “Our study shows that this process of reorganization is supported by extensive changes in the expression and function of key neurotransmitter receptors in the brain. This is a major undertaking, during which time the hippocampus’ ability to store spatial experiences is hampered,” says Manahan-Vaughan. read more
ministers (government) SHARE SHARE EMAIL Former Foreign Secretary S Jaishankar took charge as Union Minister for External Affairs on Friday gaining the distinction of becoming the first career diplomat to be given the key portfolio.Jaishankar, who was sworn in as the Foreign Minister about sixteen months after retiring as the Foreign Secretary, has to focus on improving India’s ties with neighbouring countries, tackling Pakistan, as well as making a mark in global forums like the G-20 alliance and the Shanghai Cooperation Organisation.A former ambassador to the US who also spent a number of years in China, Jaishankar is expected to delicately handle India’s diplomatic and economic relationship with both the countries which, at the moment, are engaged in a trade war.The touch decision of whether India should continue sourcing oil from Iran, a long-standing partner of India, at the risk of irking the US which has threatened sanctions against such action, will also need to be taken by India under the new Minister’s leadership. S Jaishankar, the first-time Minister SHARE RELATED Published on COMMENTS May 31, 2019 COMMENT S Jaishankar read more
May 30, 2019 politics COMMENT Published on SHARE Prasad is a key face of the party nationally and will be a vital cog in the wheels of the new Cabinet Ravi Shankar Prasad, who emerged victorious against the Congress’ Shatrughan Sinha in a high-stakes battle for the Patna Sahib constituency, is making his Lok Sabha debut. Prasad, who started out as a volunteer of the ABVP, the students’ wing of the RSS, played an active role in protests against Emergency. He became a member of the national executive committee of the BJP in 1995 and was elected to the Rajya Sabha for the first time in 2000. Prasad has held Minister of State portfolios in the Atal Behari Vajpayee-led government and was appointed the BJP’s national spokesperson in 2005. As the Electronics and IT Minister in the previous Modi-led government, Prasad played a leading role in boosting the manufacturing of electronic products in India, with major players such as Samsung and Xiaomi widening their presence. Under the Digital India initiative, he also focused on setting up Common Service Centres that helped people avail digital services from the government. Prasad also served as Law Minister and handled the Triple Talaq issue. Prasad is a key face of the party nationally and will be a vital cog in the wheels of the new Cabinet. ministers (government) Elections 2019 national politics 0 SHARE SHARE EMAIL COMMENTS read more
NEW DELHI: Attacking the government in the Lok Sabha, the opposition DMK Tuesday said the condition of the farmers in the country is pathetic. Party Member S S Palanimanickam said farmers are lagging behind every other profession in the country. “BJP said that they would be doubling the income of farmers but they are only repeating the same slogan because there is a big gap between their saying and action,” he said. The member was participating in the discussion on demand for grants for department of agriculture and farmers’ welfare, and rural Development Ministry. “I am sure that in the next election also, you will be repeating the same slogan. We were expecting loan waiver but that did not happened…You are just giving peanuts to farmers,” he said. On the PM Kisan Yojna, under which the government gives Rs 6000 per annum to farmers, he said that this is a small amount. He suggested that if the government wants to double farmers income they need to give special importance to sectors like dairy, poultry and fishery. “They should get remunerative prices,” he said. Ramapati Ram Tripathi (BJP) said the Budget mainly focuses on village people and farmers. The Budget would also help in doubling the income of farmers. “Rs 6,000 is not a small amount and this will help small farmers in crucial times. They do not have to approach moneylenders now,” he said, adding the amount is helping them in buying seeds and urea. For urea, farmers do not have to stand in queues due to the steps taken by the government, he said. Download The Times of India News App for Latest India News.XStart your day smart with stories curated specially for you read more