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Item Continuity Strategies for Long-Stay PICU Patients: Consensus Statements From the Lucile Packard Foundation PICU Continuity Panel(Wolters Kluwer, 2023) Edwards, Jeffrey D.; Wocial, Lucia D.; Madrigal, Vanessa N.; Moon, Michelle M.; Ramey-Hunt, Cheryl; Walter, Jennifer K.; Baird, Jennifer D.; Leland, Brian D.; Pediatrics, School of MedicineObjectives: To develop consensus statements on continuity strategies using primary intensivists, primary nurses, and recurring multidisciplinary team meetings for long-stay patients (LSPs) in PICUs. Participants: The multidisciplinary Lucile Packard Foundation PICU Continuity Panel comprising parents of children who had prolonged PICU stays and experts in several specialties/professions that care for children with medical complexity in and out of PICUs. Design/methods: We used modified RAND Delphi methodology, with a comprehensive literature review, Delphi surveys, and a conference, to reach consensus. The literature review resulted in a synthesized bibliography, which was provided to panelists. We used an iterative process to generate draft statements following panelists' completion of four online surveys with open-ended questions on implementing and sustaining continuity strategies. Panelists were anonymous when they voted on revised draft statements. Agreement of 80% constituted consensus. At a 3-day virtual conference, we discussed, revised, and re-voted on statements not reaching or barely reaching consensus. We used Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence and rate the statements' strength. The Panel also generated outcome, process, and balancing metrics to evaluate continuity strategies. Results: The Panel endorsed 17 consensus statements in five focus areas of continuity strategies (Eligibility Criteria, Initiation, Standard Responsibilities, Resources Needed to Implement, Resources Needed to Sustain). The quality of evidence of the statements was low to very low, highlighting the limited evidence and the importance of panelists' experiences/expertise. The strength of the statements was conditional. An extensive list of potential evaluation metrics was generated. Conclusions: These expert/parent-developed consensus statements provide PICUs with novel summaries on how to operationalize, implement, and sustain continuity strategies for LSP, a rapidly growing, vulnerable, resource-intensive population in PICUs.Item Demand Controlled Ventilation Energy Savings for Air Handling Units(2021-12) Blubaugh, Matthew; Chen, Jie; Razban, Ali; Goodman, DavidHeat, cooling, and ventilation units are major energy consumers for commercial buildings, they can consume as much as 50% of the total annual power usage of a building. Coherent management of an air handling system’s energy is a key factor of reducing the energy costs and CO2 emissions that are associated with the demand for ventilating and conditioning the air in a building. The issue is that buildings are frequently over ventilated as a full assessment of the air handling unit (AHU) data is not evaluated by building operators. According to ASHRAE standards there are three key parameters that control indoor air quality (IAQ); these are the temperature, humidity, and CO2. Commonly occupancy setpoints implemented by building operators are focused on temperature and humidity control while neglecting the CO2 levels and their impact. While this may seem insignificant additional data proves to be important and can assist with energy management. Additionally, it can develop awareness of implementable procedures which conserve energy. Furthermore, data is not monitored in regard to the continuous assessment of the energy consumption with respect to analysis of opportunities to implement energy saving control strategies. By using these standards as a guide an AHUs energy can be managed more effectively by measuring the data and assessing the outputs compared to the standard. Previous research has shown that up to 75% savings for the ventilation fan energy is achievable when taking into account ASHRAE ventilation standards and controlling outside air ventilation, however, this research has omitted investigating the savings for other energy consumers associated with AHU’s operation. In order to assess the demand, it is required that the CO2 levels of the occupied zones be measured, and the outdoor air ventilation rate be adjusted based on real-time demand. The goal of the research is to assess the number of CO¬2 sensors needed to accurately measure demand-based needs for ventilation and determine an algorithm that will help building operators assess the energy savings by implementing demand-controlled ventilation (DCV) procedures. The scope of this research is to identify what sensors at minimum are required to collect the most pertinent data for implementation of a comprehensive energy saving algorithms and assess the impact on energy consumption of AHUs when demand-controlled ventilation procedures are implemented.Item Middle East respiratory syndrome coronavirus – The need for global proactive surveillance, sequencing and modeling(Elsevier, 2021) Al-Tawfiq, Jaffar A.; Petersen, Eskild; Memish, Ziad A.; Perlman, Stanley; Zumla, Alimuddin; Medicine, School of MedicineItem A Novel 2-Hit Zebrafish Model to Study Early Pathogenesis of Non-Alcoholic Fatty Liver Disease(MDPI, 2022-02-17) Kulkarni, Abhishek; Ibrahim, Sara; Haider, Isra; Basha, Amina; Montgomery, Emma; Ermis, Ebru; Mirmira, Raghavendra G.; Anderson, Ryan M.; Medicine, School of MedicineNonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in adults. NAFLD progresses from benign liver fat accumulation to liver inflammation and cirrhosis, and ultimately leads to liver failure. Although several rodent models have been established for studying NAFLD, they have limitations that include cost, speed of disease development, key dissimilarities, and poor amenability to pharmacological screens. Here, we present a novel 2-hit zebrafish model to replicate aspects of NAFLD pathogenesis. We fed zebrafish larvae a high-fat diet (HFD) to drive liver fat accumulation (first hit). Next, we exacerbated liver-specific inflammation using a transgenic line (fabp10-CETI-PIC3) that induces the expression of proinflammatory cytokines following induction with doxycycline (second hit). These hits promoted fat accumulation and liver inflammation, as demonstrated by the high expression of inflammatory cytokines, macrophage infiltration, stress induction, and hepatic lipid droplet accumulation. Furthermore, zebrafish in this paradigm showed deranged glucose metabolism. To validate a small-molecule screening approach, we treated HFD-fed fish with pioglitazone, a drug shown to be beneficial for NAFLD in humans, and measured a sharp reduction in liver lipid accumulation. These results demonstrate new utility for zebrafish in modeling early NAFLD pathogenesis and demonstrate their feasibility for in vivo screening of new pharmacological interventions.Item Testing of a Health-Related Quality of Life Model in Patients with Heart Failure: A Cross-Sectional, Correlational Study(Elsevier, 2022) Heo, Seongkum; Lennie, Terry A.; Moser, Debra K.; Dunbar, Sandra B.; Pressler, Susan J.; Kim, JinShil; School of NursingPsychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL.