A simple, educational program for new ileostomy patients that includes preoperative teaching, standardized teaching materials, in-hospital engagement, observed management, and postdischarge tracking of intake and output is very effective in decreasing hospital readmission. The average length of stay remained stable, despite the addition of this teaching program to our perioperative/inpatient care.
As water scarcity worsens globally, there is growing interest in finding ways to reduce water consumption, and for reallocating water savings to other uses including environmental restoration. Because irrigated agriculture is responsible for more than 90% of all consumptive water use in water-scarce regions, much attention is being focused on opportunities to save water on irrigated farms. At the same time, many recent journal articles have expressed concern that claims of water-saving potential in irrigation systems lack technical credibility, or are at least exaggerated, due to failures to properly account for key elements of water budgets such as return flows. Critics have also asserted that opportunities for reallocating irrigation savings to other uses are limited because any freed-up water is taken up by other farmers. A comprehensive literature and internet survey was undertaken to identify well-documented studies of water-saving strategies in irrigated agriculture, as well as a review of case studies in which water savings have been successfully transferred to other uses. Our findings suggest that there is in fact considerable potential to reduce consumptive water use in irrigation systems when proper consideration is given to water budget accounting, and those savings can be beneficially reallocated to other purposes.
Background Burnout, “a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment”, afflicts approximately one third of plastic surgery attending surgeons and residents. Burnout can be detrimental to resident training and patient outcomes. Therefore, cultivating wellness during residency is essential. In fact, the Accreditation Council for Graduate Medical Education requires residency programs to create learning and working environments that optimize faculty and resident wellness. With increasing social media use by plastic surgery residency programs, this study aimed to analyze their posts for wellness-related content. Methods Integrated plastic surgery residency programs were obtained from the American Council of Academic Plastic Surgeons Web site, and their associated social media accounts were identified. The authors reviewed all post images, captions, and comments made by the program's account, until July 3, 2021. Any hashtags relating to wellness were also recorded. Results Of 82 programs, 76 (92.7%) had active Instagram accounts, 31 (37.8%) had active Facebook accounts, and 30 (36.6%) had active Twitter accounts. Instagram had higher rates of engagement than Facebook and Twitter (P < 0.001). Across all platforms, the mean percent of total posts related to wellness was 18.87%. The most common wellness content showcased resident work-life balance (48.73%), followed by educational events incorporating wellness activities (27.61%), attention to physical health (17.71%), healthy work environments (5.29%), wellness-specific activities (3.25%), team building activities (2.40%), and images implying but not directly showing resident wellness (1.46%). Programs did not vary significantly in percentages of total posts related to wellness by geographic region, ranking, or accreditation length. In total, 1893 wellness-related hashtags were used on Instagram, 253 on Facebook, and 72 on Twitter. The most used wellness-related hashtag was #residentlife. Only 40.8% to 50.8% of posts using wellness hashtags met at least 1 wellness criterion. Conclusion Despite the importance of burnout prevention during plastic surgery residency, less than a quarter of residency program social media content promote wellness. Social media can demonstrate how residency programs are incorporating wellness into their curricula, but whether residencies lack sufficient wellness initiatives or are not advertising such programming on their social media accounts remains to be studied.
Glioblastoma multiforme (GBM) is the most common adult primary brain malignancy, with dismal survival rates of ~14.6 months. The current standard-of-care consists of surgical resection and chemoradiotherapy, however the treatment response is limited by factors such as tumour heterogeneity, treatment resistance, the blood–brain barrier, and immunosuppression. Several immunotherapies have undergone clinical development for GBM but demonstrated inadequate efficacy, yet future combinatorial approaches are likely to hold more promise. Olaparib is FDA-approved for BRCA-mutated advanced ovarian and breast cancer, and clinical studies have revealed its utility as a safe and efficacious radio- and chemo-sensitiser in GBM. The ability of Olaparib to enhance natural killer (NK) cell-mediated responses has been reported in prostate, breast, and lung cancer. This study examined its potential combination with NK cell therapies in GBM by firstly investigating the susceptibility of the GBM cell line T98G to NK cells and, secondly, examining whether Olaparib can sensitise T98G cells to NK cell-mediated responses. Here, we characterise the NK receptor ligand profile of T98G cells and demonstrate that Olaparib does not dampen T98G susceptibility to NK cells or elicit immunomodulatory effects on the function of NK cells. This study provides novel insights into the potential combination of Olaparib with NK cell therapies for GBM.
This case helps prepare students for internships and careers in the audit profession by providing them with a realistic simulation of year-end substantive testing of Accounts Receivable. Students are given an audit program for testing management's assertions for the Accounts Receivable balance, and they are provided realistic supporting documentation with which to conduct their tests. Throughout the simulation, students will perform the following procedures: (1) identifying the correct supporting documents for each test and how to perform the required test work, (2) learning how to properly document their findings, (3) identifying any audit issues that arise during the performance of their test work, (4) rendering judgment for common issues that arise during the audit of the revenue cycle, (5) tying the supporting work papers to the trial balance and financial statements, and (6) understanding how an auditor can provide reasonable assurance about an account balance through substantive test work.
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