Abstract 186: Telestroke Networks Provide a Halo Effect for Non-Stroke Service Lines

Introduction: Hub-and-spoke TS networks link tertiary and community hospitals, typically resulting in increased stroke transfer rates between them. We hypothesized that such linkages may create a “halo effect” of downstream benefits to non-stroke service lines. The hub-and-spoke University of Utah (UU) TS Network includes 29 hospitals in 6 states and provides an excellent testbed for our hypothesis. Methods: We used business analytics to study all patients transferred to UU from a TS spoke, regardless of diagnosis. Using each spoke as its own control, we compared transfers 24 mo pre-TS initiation to 24 mo post. TS initiation was part of a coordinated UU outreach program which included initiation of ICU or Burn teleprograms during the study period for 5 sites. We excluded spokes with <5 average transfers / mo or if data was unavailable. Case severity was determined by Medicare Severity Diagnosis Related Groups (MSDRG). Contribution margin (CM) included downstream value to UU for 12 mo post transfer (data available 2013-19). Results: Data analysis included 20,353 transfers from 13 spokes in 5 states (initiation dates 2011-15). The mean number of monthly transfers pre-TS initiation was 13.9±5.0 vs 21.0±17.7 post (p<0.001) resulting in a 30% mean compounded annual growth rate (p<0.001, Fig 1A ). High growth service lines included acute / intensive medicine (155%), behavioral health (110%), neurosciences (89%), and oncology (71%). There was no change in transferred case severity ( Fig 1B) and thus no change in mean CM nor wRVU. However increased transfer volumes led to an increased number of high value (>96% CM) cases, creating an inflection point in the linear trend of number of transferred high value episodes (R 2 = 0.66 , Fig 1C ). Conclusion: This data suggests that when part of a larger outreach strategy, TS networks can create a halo effect for non-stroke hub service lines by increasing overall transfer volumes. The impact of such volume growth on commercial payer CM is exponential.

Design of Microplate-Compatible Illumination Panels for a Semiautomated Benchtop Pipetting System

Microplates are an essential tool used in laboratories for storing research materials and performing assays. Many types of laboratory automation exist that greatly reduce the effort needed to utilize microplates; however, there are cases where the use of such automation is not feasible or practical. In these instances, researchers must work in an environment where liquid handling operations are performed manually with handheld pipetting devices. This type of work is tedious and error-prone as it relies on researchers to manually track a significant amount of metadata, including transfer volumes, plate barcodes, well contents, and well locations. To address this challenge, we have developed an open-source, semiautomated benchtop system that facilitates manual pipetting using visual indicators. This device streamlines the process of identifying the location of wells so that the researcher can perform manual transfers in a more efficient, reliable, and accurate manner. This system utilizes a graphical user interface that allows the user to load worklists and then issues commands to illuminate wells of interest, providing a visual indicator for users to follow in real time. The software and hardware tools utilized for development, along with the implementation techniques used to produce this system, are described within.

Apparent molar volume of some ω-amino acids in aqueous electrolyte systems

Apparent molar volumes (Vϕ) of some ω-amino acids have been determined in aqueous guanidine hydrochloride (6 m GuHCl) and sodium sulphate (2 m Na2SO4) solutions at 288.15 and 298.15 K using a vibrating tube digital densimeter. The transfer volumes of amino acids from water to aqueous electrolyte systems have been reported. The transfer properties are interpreted in terms of strong interactions, based on a cosphere overlap model of guanidine hydrochloride/sodium sulphate molecules with the charged centers of the zwitterions (amino acid molecules), as compared to ion - nonpolar group interactions.Key words: amino acids, denaturation, guanidine hydrochloride, sodium sulphate, apparent molar volume, zwitterions, limiting apparent molar volume.

Apparent molar volumes of glycine, L-alanine, and L-serine in water + ethanol mixtures at 298.15 K

Densities of glycine, L-alanine, and L-serine have been measured with an oscillating-tube densimeter at 298.15 K in water + ethanol (EtOH) mixtures ranging from pure water to 45% ethanol by mass. From these densities, apparent molar volumes and limiting apparent molar volumes of the three amino acids in the mixtures have been calculated. Transfer volumes are interpreted in terms of the structure-making or structure-breaking effects of water on addition of these amino acids in the mixtures. The relative contributions of hydrophilic and hydrophobic interactions in these solutions have been inferred.Key words: glycine, L-alanine, L-serine, water + ethanol mixtures, densities.