Northeastern Ohio Research Articles

Strengthening Role Clarity in Acute Care Nurse Case Managers

The purpose of this quality improvement study was to evaluate the impact of a novel educational intervention on nurse case managers' (NCMs') perceived role ambiguity, role conflict, and use of nursing competencies. Specific aims were to apply the American Association of Critical-Care Nurses Synergy Model for Patient Care to determine the use of the model's nurse competencies in acute care case management, to pilot test the feasibility of using widely available basic computer technologies to facilitate NCMs' orientation in acute care settings, and to establish the foundation for future work in developing an evidence-based orientation program for new NCMs based on a nursing conceptual framework. Two acute care community hospitals in northeastern Ohio, both part of a large national hospital corporation. The sample consisted of NCMs who were actively employed in 1 of 2 acute care hospitals and voluntarily agreed to participate in this quality improvement study. Data on perceived role conflict and role ambiguity, perceived use of nurse competencies in bedside nursing and in case management, demographics, and evaluative feedback were collected using Google Docs. The intervention consisted of a series of four self-paced computer-based learning modules that provided participants with an introduction to acute care nursing case management based on the American Association of Critical-Care Nurses Synergy Model. Four of the 6 role ambiguity subscale item scores revealed reductions in role ambiguity after the educational intervention. A statistically significant decrease in one role conflict item was observed. Participants rated the use of all nurse competencies as higher in case management than in bedside nursing practice; the variance between the two further increased after the intervention. Statistically significant differences in the use of clinical judgment, advocacy/moral agency, and caring practices were identified. Participants reported that the educational content would be valuable for new NCMs transitioning from bedside clinical practice. The addition of case studies or clinical scenarios illustrating each nurse competency was suggested. Testing of the Synergy Model-based education modules with novice case managers actively transitioning from the bedside to a case management role will be the next step in the development of this program. : The use of widely available computer technologies to deliver introductory case management orientation content is feasible, although conversion to a web-based platform is recommended. Evidence-based strategies to prepare NCMs for expanded competency in clinical judgment, advocacy/moral agency, and caring practices are needed.

Microbial quality and bacteria pathogens in private wells used for drinking water in northeastern Ohio

In agricultural intensive areas, drinking contaminated water from private wells is considered an important cause of acute gastroenteric illnesses (AGI), particularly among high-risk populations. In the summer of 2009, the microbial water quality of 180 randomly selected private wells in two northeastern Ohio counties, a region with a high concentration of dairy farms, was assessed. Forty-five percent (82/180) of water samples were contaminated with total coliforms. Generic Escherichia coli were present in 9% (16/180) of samples. Using real-time polymerase chain reaction, E. coli O157:H7 was identified in 4% (7/180) of specimens. Campylobacter spp. DNA could not be amplified from 70 of the samples tested for this organism. The frequency of generic E. coli contamination varied among townships (P < 0.001). Well structure (i.e. age and depth) or other common measures of pollution potential (depth of water, hydrology, topography, net recharge soil media) was not correlated with coliforms and E. coli contamination. Importantly, the presence of the pathogen E. coli O157:H7 was not associated with the presence of fecal indicators in the water samples: Only one of the seven E. coli O157-positive samples was also positive for generic E. coli. Appropriate risk management and communication processes are needed to reduce the potential waterborne disease outbreaks in agricultural intensive areas.

Newborn Weight Change and Breastfeeding Practice During First Days of Life

<h2>Newborn Care Paper Presentation</h2><h3>Objective</h3> To determine a natural weight loss for breastfed, exclusive, and nonexclusive newborns that are not exposed to common medical interventions in a hospital setting. <h3>Design</h3> Retrospective. <h3>Setting</h3> A freestanding, nonprofit birth center in Northeastern Ohio. <h3>Sample</h3> Healthy, breastfeeding (BF) mothers who were 18 years and older with uncomplicated vaginal deliveries. Healthy, full‐term singleton infants with no apparent facial deformity/malformations and 5‐minute APGARS > 7 were included. <h3>Methods</h3> Random charts were selected from 2009 to 2010. Variables of interest during first days postdelivery included elimination patterns (number of voids and number of stools), weight change (birth weight and a subsequent weight measurement within first days), and mothers documented number of BF episodes. Data regarding medication and intravenous fluids during labor were also collected. <h3>Results</h3> A total of 110 randomly selected charts were reviewed, 69 infants had a weight measurement within the first 24 hours, and 36 were exclusively breastfed. During the first 24 hours, the mean percent of weight loss was 2.9% for exclusively breastfed infants and 2.5% for nonexclusively breastfed infants. Infants breastfed an average of eight times and were provided supplemental feedings twice. At discharge (44‐45.9 hours post birth), the mean weight loss was 5.1% for exclusively breastfed infants and 4.9% for nonexclusively breastfed infants. <h3>Conclusion/Implications for Nursing Practice</h3> Weight changes in the newborn during the initial days after delivery are scrutinized by the medical birthing facilities. Weight gain or more commonly weight loss drive the need for supplementation of the breastfed newborn. Having an initial weight loss of 7% or more during the first days of life is reason to give artificial milk to breastfed newborns. There is very limited literature that determines how a 7% weight loss was used as the guideline to supplement for weight loss. Breastfed newborns do lose weight in the first days of life when there are minimal medical interventions available in the birthing environment. This study is a first step in establishing a baseline for weight loss in exclusively breastfed newborns. More studies are needed to better understand the weight change patterns and BF practices in infants born in environments with minimal medical interventions versus nonminimal medical interventions <i>t</i> within the first days post birth.

The Impact of Postintubation Chest Radiograph During Pediatric and Neonatal Critical Care Transport

Tracheal intubation is necessary in the setting of pediatric/neonatal critical care transport but information regarding usefulness and efficiency of a confirmatory postintubation chest radiograph is limited. We hypothesize that routine postintubation chest radiograph to confirm tracheal tube position is not informative and can be eliminated to improve efficiency without compromising safety in transport. This was a prospective observational study. The primary study outcome was the rate of tracheal tube repositioning after postintubation chest radiograph and the secondary outcome was the on-scene time. Additional data obtained included the initial accuracy of tracheal tube depth based on Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. A children's hospital-based pediatric/neonatal critical care transport team in northeastern Ohio. All pediatric/neonatal patients intubated by the transport team during the 18-month study period (January 2009-July 2010). There were 77 patients enrolled (43 pediatric, 34 neonatal). A postintubation chest radiograph was obtained 85.7% of the time and showed tracheal tube malposition in 47% of cases. No difference was seen in the rate of malpositioned tracheal tubes in the neonatal group compared with pediatric group (51.7% vs. 43.2%, p = 0.54). The calculated tracheal tube depth based on the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines was correct in 50% of the neonates and 41.9% of the pediatric patients. In patients with appropriate initial tracheal tube depth by calculations, the tracheal tube was repositioned at similar rates after postintubation chest radiograph in both neonatal and pediatric patients (50% vs. 41.9%, p = 0.48). When comparing mean onscene times for patients with/without a postintubation chest radiograph, the neonatal patients saved 33 minutes on average when no chest radiograph was obtained (mean ± sd: 60.6 ± 35.8 min vs. 93.8 ± 23.8 min, p = 0.01). There was no statistical difference in on-scene time for pediatric patients whether they did or did not receive a postintubation chest radiograph. Although postintubation chest radiographs may extend the overall on-scene transport times in select patients, our data show that the postintubation chest radiographs remain informative in pediatric/neonatal critical care specialty transport and should be obtained when feasible.

Use of dairies by postreproductive flocks of European starlings

Knowledge of the behavior and movement patterns of European starlings (Sturnus vulgaris L.) is important to wildlife managers that seek to resolve conflicts at livestock facilities. We captured and radio tagged 10 starlings at each of 5 dairies in northeastern Ohio. From September 19 to October 31, 2007, we obtained sufficient data from 40 birds to study their behavior and movements. The birds visited the dairies where they were initially captured (home sites) on 85% of the days, spending 58% of each day at the dairies. Onsite arrival and departure times were 2.5h after sunrise and 3.1h before sunset. Daily visits by radio-tagged cohorts from the other dairies were greatest for the 2 most proximate dairies (1.3 km apart), with number of visits between this pairing >7× that of the 9 other pairings combined (4.1–6.5 km apart). Two birds used their home sites intermittently as roosts, arriving 3.8h before sunset and departing 0.2h after sunrise. In addition to using home-site roosts, these birds also used a distant roost (22km) that was used by 36 of the 40 birds. The efficacy of starling management programs, especially lethal management, depends on degree of site fidelity, use of other facilities, and roosting behavior. For example, starlings that use dairies as roosting sites may require a different management strategy than required at dairies used as daytime sites because of differences in arrival and departure behavior. Our research will help resource managers evaluate current management strategies already in place and change them, if needed, to fit the behavior profile of starlings using dairies and other types of livestock facilities.

Precipitation data considerations for evaluating subdaily changes in rainless periods due to climate change

Quantifying magnitudes and frequencies of rainless times between storms (TBS), or storm occurrence, is required for generating continuous sequences of precipitation for modeling inputs to small watershed models for conservation studies. Two parameters charac- terize TBS, minimum TBS (MTBS) and average TBS (ATBS)—both vary monthly and are calculated by assuming TBS follows an exponential distribution. Detecting changes in these parameters due to climate is important for precipitation and climate studies at short time and small spatial scales, but there are issues with depth resolution of precipitation data that must first be investigated. Precipitation data having one-minute temporal and 0.25 mm (0.01 in) depth resolutions from the UDSA Agricultural Research Service North Appalachian Experimental Watershed (NAEW) at Coshocton, Ohio, were used to determine the spatial variability and consistency of estimates over the 425 ha (1,050 ac) facility and the impacts of coarsening the depth resolution of data 10 times to 2.54 mm (0.1 in). The magnitudes and trends of changes in MTBS and ATBS are determined for three rain gauges over the NAEW and extended to other gauges in the Ohio region. Approximately 5,800 parameter pairs were computed for different data configurations. Small spatial scale, NAEW high-res- olution precipitation data shows consistent MTBS and ATBS long-term values for each month but more variability in estimates for MTBS than ATBS. Climate change trends for MTBS and ATBS are not apparent and generally consistent for different NAEW gauges, except for November when all gauges were consistently significant for ATBS. There is a weak indication that the fall months may be affected by significant shortening of ATBS at the NAEW and in northeastern Ohio due to climate change, but more data are needed. An imposed, coarser NAEW data resolution results in consistent no-trend indications for MTBS, but not for ATBS. The coarse-resolution data may not be adequate to characterize TBS for investigating changes due to climate change unless more data preparation is performed, such as identifying and excluding dry times when precipitation may have occurred. Precipitation records with mixed resolution data cannot be used to detect climate changes of dry periods. More data and data preparation are needed to arrive at firm conclusions regarding climate change effects on TBS in Ohio.

A study of the contaminated banks of the Mahoning River, Northeastern Ohio, USA: characterization of the contaminated bank sediments and river water–groundwater interactions

The Mahoning River is one of the five most contaminated rivers in the U.S. This study characterized the contaminated sediments in the river banks and investigated the hydraulic interconnection between shallow aquifer in the banks with the river water. The study was conducted along the most polluted section of the river, which is 50-km long, using over 50 monitoring wells. The characterization part of the study investigated the sedimentology, hydraulic conductivity, and spatial distribution of the contaminated sediments. Results of the characterization revealed that the contaminated sediments consist of fine-grained sand, silt, mud, and clay. The spatial distribution of the contaminated sediment is heterogeneous and positively correlates with the hydraulic conductivity values, i.e., the greatest contamination occurs in high conductivity areas. Hydraulic conductivity was determined by the Hazen formula using 82 sediment samples. Bioremediation, which is one of the remedial options considered for the banks, is found to be hydraulically feasible because of sufficient hydraulic conductivity values (≥10−4 cm/s) that ensure reasonable rates of nutrient delivery. Monitoring of water levels in the river and groundwater for a 10-month period shows that flow occurs from the river to groundwater and vice versa. The exchange of flow is influenced by rainfall. Flow of groundwater to the river will continually transport the dissolved contaminants in groundwater to the river. Therefore, findings of this study show that one of the remedial options that proposes dredging of channel sediments and permits no action for bank sediments cannot be chosen due to river water–groundwater interactions.

The Asthma Awareness Patch Program for Girl Scouts: An Evaluation of Educational Effectiveness

Carefully designed educational programs can improve asthma knowledge, management practices, and health outcomes. We used pre-post testing to determine if the curriculum provided in the Girl Scouts of the USA Asthma Awareness Patch Program improved recipients' knowledge of basic respiratory system function, asthma pathophysiology, triggers, and asthma exacerbation recognition and management. We hypothesized that participants would have improved post-test scores following an interactive asthma educational program. Girl Scouts ages 5-17 years from a 4-county area in northeastern Ohio were recruited. Educational components were in compliance with the guidelines established by the National Heart, Lung, and Blood Institute's National Asthma Education and Prevention Program. Participants completed a demographic form and pre-test before, and a post-test and program evaluation immediately following, the program. Descriptive statistics were used to report participant demographics. Frequencies and percentages described the participants' responses to pre- and post-test questions. Cronbach's alpha analysis determined internal consistency and reliability of post-test items. T tests assessed differences in pre-post scores. Fishers exact tests determined differences in proportions of responses, between the pre- and post-test time points. A P value of < 0.05 was considered statistically significant. Eighty-six girls, between 5 and 16 years of age (mean ± SD 8.97 ± 2.36 y) participated, 84% of whom were white. Twenty-one percent of the participants were diagnosed and treated for asthma, 48% resided with an asthmatic, and 72% knew someone with asthma. The post-test scores (mean ± SD 89.6 ± 9.0) were significantly higher (P < .001) than the pre-test scores (62.5 ± 20.8). A Cronbach alpha raw score of 0.448 and a standardized score of 0.518 were realized. The assessment tool demonstrated moderate internal reliability. Participation in the program enhanced participants' knowledge of lung function, trigger identification, asthma pathophysiology, and treatment.

Molecular Epidemiology and Public Health Relevance ofCampylobacterIsolated from Dairy Cattle and European Starlings in Ohio, USA

Dairy cattle serve as a potential source for Campylobacter infection in humans. Outbreaks associated with consumption of either Campylobacter contaminated raw milk or contaminated milk after treatment were previously recorded in the United States. Further, starlings have been implicated in the spread of bacterial pathogens among livestock. Here, we determined the prevalence, genotypic, and phenotypic properties of Campylobacter isolated from fecal samples of dairy cattle and starlings found on the same establishment in northeastern Ohio. Campylobacter were detected in 83 (36.6%) and 57 (50.4%) out of 227 dairy and 113 starling fecal samples, respectively. Specifically, 79 C. jejuni, five C. coli, and two other Campylobacter spp. were isolated from dairy feces, while all isolates from starlings (n=57) were C. jejuni. Our results showed that the prevalence of C. jejuni in birds was significantly (p<0.01) higher than that in dairy cattle. The pulsed-field gel electrophoresis analysis showed that C. jejuni were genotypically diverse and host restricted; however, there were several shared genotypes between dairy cattle and starling isolates. Likewise, many shared clonal complexes (CC) between dairy cattle and starlings were observed by multilocus sequence typing (MLST) analysis. As in humans, both in cattle and starlings, the CC 45 and CC 21 were the most frequently represented CCs. As previously reported, CC 177 and CC 682 were restricted to the bird isolates, while CC 42 was restricted to dairy cattle isolates. Further, two new sequence types (STs) were detected in C. jejuni from dairy cattle. Interestingly, cattle and starling C. jejuni showed high resistance to multiple antimicrobials, including ciprofloxacin, erythromycin, and gentamicin. In conclusion, our results highlight starlings as potential reservoirs for C. jejuni, and they may play an important role in the epidemiology of clinically important C. jejuni in dairy population.

β-Glucan supplementation, allergy symptoms, and quality of life in self-described ragweed allergy sufferers.

This randomized, placebo-controlled, double-blind study compared the effects of daily supplementation for 4 week with 250 mg Wellmune WGP® β-1,3/1,6-Glucan (WGP) with placebo 250 mg/day (rice flour) on physical and psychological health attributes of self-described “moderate” ragweed allergy sufferers. Study participants (mean age = 36 ± 9 year; range 18–53 year) were recruited before the beginning of ragweed season (September) in Northeastern Ohio. Serum IgE concentration, allergy symptoms [via self-report, Visual Analog Scale (VAS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ)], psychological well-being [Profile of Mood States (POMS)], and physical function (RAND SF-36 Medical Outcomes Study) were measured immediately prior to and after supplementation with WGP (n = 24) or placebo (n = 24) for 4 weeks. Data were analyzed using repeated measures analyses of variance (ANOVA). Compared with placebo, WGP reduced total allergy symptoms (28%), symptom severity (52%), and symptom rating on the VAS (37%) (P < 0.05), but had no effect on serum IgE levels. As measured by the POMS, WGP increased participants' rating of vigor (10%), but reduced tension (34%), depression (45%), anger (41%), fatigue (38%), and confusion (34%) (P < 0.05). Study participants given WGP reported increased physical health (11%), energy (19%), and emotional well-being (7%) compared with study participants given the placebo (RAND SF-36 Medical Outcomes Study). The WGP group also reported decreased sleep problems (53%), reduced nasal symptoms (59%), eye symptoms (57%), non-nasal symptoms (50%), activities (53%), emotions (57%), and improved quality of life (QOL) (56%), as well as improved global mood state (13%). Supplementation with WGP for 4 weeks improved allergy symptoms, overall physical health, and emotional well-being compared with placebo in self-described “moderate” ragweed allergy sufferers during ragweed allergy season.

Stereotactic Radiosurgery for Renal Cancer: Phase I Safety and Toxicity

Stereotactic Radiosurgery for Renal Cancer: Phase I Safety and Toxicity R.J. Ellis, R.B. Patel, C. Kunos, Y. Zhang, J. Brindle, V. Kudithipudi, D.A. Kaminsky, and L. Ponsky; University Hospitals Seidman Cancer Center, Department of Radiation Oncology, Cleveland, OH, Case Western Reserve University Medical School, Cleveland, OH, Northeastern Ohio University College of Medicine, Rootstown, OH, University Hospitals Seidman Cancer Center, Department of Urology, Cleveland, OH

A Descriptive Analysis of Nursing Satisfaction: First-Time Versus Non-First-Time Medical-Surgical Patients

Patient assessment of satisfaction is very important in achieving high patient-retention rates in a highly competitive environment (Bendall-Lyon & Powers, 2004). This study's purpose was to analyze the perception of nursing satisfaction with first-time versus non-first-time medical-surgical patients. The study involved a patient satisfaction questionnaire sent to 2,265 discharged inpatients in a 537-bed teaching hospital in northeastern Ohio. Group means and standard deviations indicate no difference between first-time and non-first-time admits in nursing care satisfaction; therefore, it's difficult to conclude why patients' assessments were so similar. Quite possibly, all patients recognize the hard work and efforts of registered nurses.

Predictors of a Fall Event in Hospitalized Patients With Cancer

To determine predictors of fall events in hospitalized patients with cancer and develop a scoring system to predict fall events. Retrospective medical record review. A 1,200-bed tertiary care hospital in northeastern Ohio. 145 patients with cancer who did not have a fall event were randomly selected from all oncology admissions from February 2006-January 2007 and compared to 143 hospitalized patients with cancer who had a fall event during the same period. Multivariable logistic regression models predicting falls were fit. Risk score analysis was completed using bootstrap samples to evaluate discrimination between patients who did or did not fall and agreement between predicted and actual fall status. A nomogram of risk scores was created. Fall episodes during hospitalization and patient characteristics that predict falls. While patients were hospitalized for cancer care, their predictors of a fall episode were low pain level, abnormal gait, cancer type, presence of metastasis, antidepressant and antipsychotic medication use, and blood product use (all p < 0.02); risk model c-statistic was 0.89. For hospitalized patients with cancer, predictors reflecting greater fall episode risk can be assessed easily by nursing staff and acted on when the risk is sufficiently high. Understanding specific risk factors of falls in an adult oncology population may lead to interventions that reduce fall risk.

The OHDEP Project: Creating a Shared Catalog for the Northeast Ohio Depository

In 2011, the Northeastern Ohio Cooperative Regional Library Depository completed a pilot project that created a shared catalog for depository holdings. The project, coordinated by the Northeastern Ohio Cooperative Regional Library Depository Implementation Group, has paved the way for the remaining four Ohio depositories to contribute their depository holdings to the shared catalog. This paper describes the motivation for the project and the planning, implementation, and impact of a shared catalog on depository workflow and service at the Northeast Ohio Regional Depository. It also highlights implications for the improved storage capacity through statewide deduplication projects.

Camerate and disparid crinoids from the late Kinderhookian Meadville Shale, Cuyahoga Formation of Ohio

Crinoids were first reported from the Cuyahoga Formation in northeastern Ohio by James Hall in 1863. However, these crinoids have not been re-examined in detail since the late nineteenth century. With the restudy of classical and more recent collections, ten (nine camerate and one disparid) species-level taxa are recognized from the late Kinderhookian Meadville Shale Member, Cuyahoga Formation, including the camerates Amphoracrinus viminalis (Hall, 1863); Aorocrinus helice Hall, 1863; Aorocrinus meyeri n. sp.; Aryballocrinus martini n. sp.; Cusacrinus daphne (Hall, 1863); Platycrinites s.l. contritus (Hall, 1863); Platycrinites s.l. graphicus (Hall, 1863); Platycrinites s.l. lodensis (Hall and Whitfield, 1875); and Platycrinites s.l. burkei n. sp. In addition, Halysiocrinus sp. is the first disparid reported from this fauna. Platycrinites s.l. bedfordensis (Hall and Whitfield, 1875) is designated a nomen dubium. Growth is evaluated for Aorocrinus helice and Cusacrinus daphne, which had contrasting development. The growth of the Aorocrinus helice calyx was largely not allometric but that of the primaxil plate was, suggesting the arms may have grown allometrically. In contrast, much of the calyx of Cusacrinus daphne displayed allometric growth.

Cladid crinoids from the Late Kinderhookian Meadville Shale, Cuyahoga Formation of Ohio

A total of 17 species of cladid crinoids are documented from the late Kinderhookian Meadville Shale Member of the Cuyahoga Formation of northeastern Ohio, the most diverse assemblage of Kinderhookian-age cladids known in North America. One new genus, six new species, and seven new combinations are reported. New taxa include Cuyahogacrinus lodiensis new genus and species, and the new species Cyathocrinites simplex, Atelestocrinus meszarosi, Goniocrinus sceletus, Aphelecrinus gracilis, and Lebetocrinus ohioensis. New combinations include Logocrinus warreni (Laudon et al., 1952), Histocrinus aegina (Hall, 1863), Paracosmetocrinus richfieldensis (Worthen, 1882), P. corycia (Hall, 1863), Acylocrinus lyriope (Hall, 1863), Linocrinus merope (Hall, 1863), and L. paternus (Hall, 1863). Remaining taxa include Cyathocrinites lamellosus (White, 1863) and Ascetocrinus whitei (Hall, 1861), both of which also occur in the Osagean Burlington Limestone, and the endemic species Cosmetocrinus crineus (Hall, 1863) and Pachylocrinus subtortuosus (Hall, 1863).Collectively, the cosmopolitan genera and species of cladids show a greater overall affinity with Osagean cladid faunas than with other Kinderhookian cladid faunas. However, this is true for other Kinderhookian cladid faunas as well that individually have more taxa in common with Osagean faunas than other Kinderhookian faunas. This suggests a greater degree of endemism and local speciation during the Kinderhookian as a prelude to the rapid radiation of cladids, and other crinoids, during the Osagean.

Physicochemical Characteristics and Benthic Macroinvertebrate Communities in Temporary Surface Waters of Northern Stark County, Ohio

Natural habitats located in urbanized regions are increasingly being impacted by residential, commercial and agricultural development, but little is known about their biotic and abiotic characteristics. Temporary aquatic habitats are less protected by environmental regulations than permanently flooded habitats, and they have been historically understudied. We sampled temporary aquatic habitats including vernal pools, other emergent wetlands and intermittent streams in northeastern Ohio over a two-year period to characterize the macroinvertebrate communities and abiotic characteristics of each habitat type. Duration of inundation of the habitat was the single largest contributing factor to benthic macroinvertebrate community structure. Macroinvertebrate community variability was greater among habitat types than within types suggesting that different habitats type do play a role in selecting for different invertebrate species. Macroinvertebrate abundance and diversity, and functional feeding group patterns differed among seasons. Dissolved oxygen, oxidation-reduction potential and conductivity explained a significant portion of the variability in macroinvertebrate community structure, and these differed among habitat types. Our results suggest that abiotic characteristics have a greater role in determining macroinvertebrate community structure than habitat type.

Effect of an iPod Video Intervention on Consent to Donate Organs

The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups. To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation. Cluster randomized, controlled trial. Randomization was performed by using a random-number table with centralized allocation concealment. Participants and investigators assessing outcomes were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00870506) Twelve branches of the Ohio Bureau of Motor Vehicles in northeastern Ohio. 952 participants aged 15 to 66 years. Video (intervention; n = 443) or usual Bureau of Motor Vehicles license practices (control; n = 509). The primary outcome was the proportion of participants who provided consent for organ donation on a newly acquired driver's license, learner's permit, or state identification card. Secondary outcomes included willingness to make a living kidney donation to a family member in need and personal beliefs about donation. More participants who viewed the video consented to donate organs than control participants (84% vs. 72%; difference, 12 percentage points [95% CI, 6 to 17 percentage points]). The video was effective among black participants (76% vs. 54%; difference, 22 percentage points [CI, 9 to 35 percentage points]) and white participants (88% vs. 77%; difference, 11 percentage points [CI, 5 to 15 percentage points]). At the end of the trial, fewer intervention than control participants reported having insufficient information about organ donation (34% vs. 44%; difference, -10 percentage points [CI, -16 to -4 percentage points]), wanting to be buried with all of their organs (14% vs. 25%; difference, -11 percentage points [CI, -16 to -6 percentage points]), and having conflicts with organ donation (7% vs. 11%; difference, -4 percentage points [CI, -8 to -2 percentage points]). How the observed increases in consent to donate organs might translate into a greater organ supply in the region is unclear. Exposure to a brief video addressing concerns that ethnic groups have about organ donation just before obtaining a license, permit, or identification card increased consent to donate organs among white and black participants. National Institutes of Health and the Robert Wood Johnson Foundation.

Abstract 3379: Benefiting the Community; The Impact of Joining a Regional Stroke Network

Background: The Cleveland Clinic Health System (CCHS) consists of a large tertiary care center and 10 regional hospitals. It is organized both clinically and administratively into multispecialty organ based Institutes rather than departments. The CCHS re-introduced a regional initiative to standardize stroke care in 2008. Medina Hospital is a 118-bed community hospital in rural North-eastern Ohio, where there is a high stroke burden and previously minimal IV tPA use. Medina Hospital joined the CCHS Stroke Network in November 2009. Hypothesis: We hypothesized that after joining the formally organized stroke CCHS system of care, the proportion of stroke patients receiving IV tPA and the timeliness of administration of acute thrombolytic therapy would both significantly increase. Methods: Data was analyzed from our prospective participation in the Get with the Guidelines-Stroke and the Ohio Coverdell Stroke Registries. Baseline data regarding quality, outcomes and stroke performance measures were reviewed. CCHS initially supported acute stroke care in early 2010 with a telemedicine cart and then introduced 24/7 emergency, on-site, CCHS neurologist, acute stroke call coverage in late 2010. Standardized CCHS stroke care pathways and order sets were also introduced in 2010. The proportion of stroke patients treated with IV tPA in 2010 and 2011 (post- joining CCHS) was compared to 2009 (2-sided Fisher’s exact test), and door-to-needle times were compared from 2010 to 2011 (unpaired t-test). Results: IV tPA treatment utilization increased from 0/69 patients (0%) in 2009 to 9/67 patients (11.8%) in 2010 [exact p=.0033] and 11/46 (19.3%) in the first 7 months of 2011 [exact p=.0001]. Door-to-needle times improved from a mean of 81.4 (95%CI 66.4 to 96.4) minutes in 2010 to 61.7 (95% CI 52.7 to 70.8) minutes in 2011 (p=.0158). Conclusions: Participation in an organized formal collaborative regional hospital stroke treatment network resulted in dramatic improvements from zero IV tPA utilization to greatly exceeding the national benchmark averages for both percentage treatment with IV tPA and door-to-needle time in a rural area where patients previously had minimal access to acute stroke expertise.

Perceived value and strategic importance of supply chain options: multi-firm case study

Manufacturing management traditionally has focused on orderfulfillment activities, ignoring the many tools available for efficient transfer of information, supplier partnering, and effective processes involved in getting a product to market and enhancing customer satisfaction activities via supply chain management. A discussion of integral and modular manufacturing enhanced with supply chain design elements was attempted via a case study of five northeastern Ohio manufacturing companies with global presence. The following paper highlighted the significant differences in supply chain design and management, firm structure and operations, the type of products manufactured and business level strategies it utilized in SCM activities.