Assessment of quality indicators among nurse practitioners performing upper endoscopy.

BACKGROUND AND STUDY AIMS: Limited international data have shown that non-physicians can safely perform upper endoscopy, but no such study has been performed in the United States. Our aim was to assess the quality of outpatient upper endoscopies performed by nurse practitioners (NPs). PATIENTS AND METHODS: Retrospective chart review of upper endoscopies performed by 3 NPs between 2010 and 2013 was performed. Comparisons among all NPs performing upper endoscopy and assessment of individual NP performance over time with respect to quality indicators were performed. RESULTS: Three NPs performed 333 upper endoscopies (distribution of 166, 44, and 123, respectively). Of the cases, 98.2 %s were successfully completed to the second portion of the duodenum. In most cases, photo-documentation of required anatomical landmarks was performed: GE junction (84.2 %), GE junction in retroflexed view (84.2 %), antrum (82.1 %) and duodenum (80.9 %). Photo-documentation improved with increasing experience. NPs appropriately performed biopsies for specific medical conditions: 10/11 (90.9 %) gastric ulcers were biopsied and 63/66 (95.5) of patients with iron deficiency had duodenal biopsies performed for celiac disease. A physician endoscopist was required during the procedure 22.5 % of the time. Important parameters such as documenting informed consent (100 %) and documenting a discharge plan (99.4 %) in the procedure reports were overwhelming present. There was a single adverse event during the study period. CONCLUSION: In the first US study of NPs performing upper endoscopy, they were able to perform high-quality and safe upper endoscopies. These findings support incorporation of non-physicians alongside physicians to help meet the growing demand for endoscopic services across the United States.

Multichannel tunable imager architecture for hyperspectral imaging in relevant spectral domains.

In this paper, we present a technique for dimensionality reduction in hyperspectral imaging during the data collection process. A four-channel hyperspectral imager using liquid crystal Fabry-Perot etalons has been built and used to verify this method for four applications: auroral imaging, plant study, landscape classification, and anomaly detection. This imager is capable of making measurements simultaneously in four wavelength ranges while being tunable within those ranges, and thus can be used to measure narrow contiguous bands in four spectral domains. In this paper, we describe the design, concept of operation, and deployment of this instrument. The results from preliminary testing of this instrument are discussed and are promising and demonstrate this instrument as a good candidate for hyperspectral imaging.

LiCHI - Liquid Crystal Hyperspectral Imager for simultaneous multispectral imaging in aeronomy.

A four channel hyperspectral imager using Liquid Crystal Fabry-Perot (LCFP) etalons has been built and tested. This imager is capable of making measurements simultaneously in four wavelength ranges in the visible spectrum. The instrument was designed to make measurements of natural airglow and auroral emissions in the upper atmosphere of the Earth and was installed and tested at the Poker Flat Research Range in Fairbanks, Alaska from February to April 2014. The results demonstrate the capabilities and challenges this instrument presents as a sensor for aeronomical studies.

Point-of-Care Ultrasound and the Rapid Response System.

Over the years, the use of ultrasound has moved solely from the domain of the radiologist to that of the intensivist and emergentologist for use in acute care settings. By virtue of its ease of use and rapid learning curve to proficiency, we are now seeing an increased desire by internists to learn the modality and apply it at the patient's bedside. The rapid response system represents a rational starting point for the introduction of point-of-care ultrasound to the inpatient ward setting.

The sources of sodium escaping from Io revealed by spectral high definition imaging.

On Jupiter's moon Io, volcanic plumes and evaporating lava flows provide hot gases to form an atmosphere that is subsequently ionized. Some of Io's plasma is captured by the planet's strong magnetic field to form a co-rotating torus at Io's distance; the remaining ions and electrons form Io's ionosphere. The torus and ionosphere are also depleted by three time-variable processes that produce a banana-shaped cloud orbiting with Io, a giant nebula extending out to about 500 Jupiter radii, and a jet close to Io. No spatial constraints exist for the sources of the first two; they have been inferred only from modelling the patterns seen in the trace gas sodium observed far from Io. Here we report observations that reveal a spatially confined stream that ejects sodium only from the wake of the Io-torus interaction, together with a visually distinct, spherically symmetrical outflow region arising from atmospheric sputtering. The spatial extent of the ionospheric wake that feeds the stream is more than twice that observed by the Galileo spacecraft and modelled successfully. This implies considerable variability, and therefore the need for additional modelling of volcanically-driven, episodic states of the great jovian nebula.