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Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity.

Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime.

Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon.

Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability.

Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved.

Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

There have always been traditional differences between the various regions of the British Isles. For example, meat consumption is greater in the North than the South; most families take some meat at every meal and this extends to the children. The North is the home of the savoury meat products, eg., faggots, rissoles and similar preparations and a high meat content for such foods as sausages is expected; between 80 and 90% with the cereal only present for binding purposes. Present minimum meat contents would be considered a swindle, also the nature of the lean meat and the lean meat/fat ratio. The high water content similarly would have been unacceptable.

Purpose: Lesbian, gay, and bisexual (LGB) young adults smoke at rates much higher than the general population. Young adults, in general, are less likely to seek medical help for smoking cessation and LGB individuals are less likely to seek health care generally. Alternative methods to encourage smoking cessation are necessary. This research seeks to establish whether LGB young adults in California would be willing to use social media for smoking cessation.

Approach: We conducted 41 qualitative interviews among LGB young adults in the San Francisco Bay Area and Los Angeles in Fall 2014.

Findings: The results suggest that our participants were interested in a LGB-focused social media intervention, as long as the intervention was private or anonymous and moderated. Further, across topical areas our participants spoke extensively about the import of social connections. We may be able to leverage these connections to encourage cessation.

Research Limitations: This is a qualitative, non-generalizable dataset from a fairly limited geographic area.

Public Health Implications: Online smoking cessation interventions aimed at young adults would benefit from further testing with LGB young adults to ensure efficacy among this population. In addition, states and localities concerned about young adult LGB smoking might benefit from investing in an online socially mediated cessation forum. Online interventions could be scalable and might be useful for other groups who regularly face discrimination, stigma, or other stressors that make successful smoking cessation difficult.

Shops and shopkeepers are a British tradition. More than 150 years ago, we were a nation of shopkeepers, and the picture of shops and the shopping public seemed unchanging. There were, of course, the early departmental stores, the co‐operative societies, the multiple shops, the chain‐stores, but the position was much as it had always been and the greatest proportion of retail trade was still in the hands of the traditional type of shopkeeper. The two Wars changed many things, but it was not until after the last War that retail trade really began to change and looking at it objectively and at the food trade particularly, it has become a revolution.

The purpose of this paper is to discuss a unique leadership curriculum developed at the University of Florida and its impact on the leadership skills and values of the anesthesiology residents since its conception. The authors instituted a voluntary anesthesiology residency leadership development program at their institution to fill a perceived gap in leadership training. Mounting evidence reveals that strong clinical leadership skills improve outcomes for patients and health-care institutions. Additionally, this growing body of literature indicates that optimal outcomes result from effective team behaviors and skills, which are directed through the requisite clinical leadership. Unfortunately, adding leadership training into the existing medical education curriculum is a formidable challenge regardless of the level of learner.

To evaluate learners, the authors used the Aspiring leaders in Healthcare-Empowering individuals, Achieving excellence, Developing talents instrument, which is a validated and reliable assessment of leadership competency in health-care professionals. In 2017, the authors surveyed the past five graduating classes from the department (classes of 2012-2016), using the two graduating classes before the program’s implementation as a historical control group.

The survey was sent to 96 people, of whom 70 responded (73 per cent). Those participants who usually or always participated in the program responded with higher leadership-readiness skills scores than those who occasionally, rarely or never participated in the program. Notably, those who had participated in another leadership development course at any time had higher skills scores than those who had never participated.

The study’s data provide evidence that residents who either, often or always participated in the leadership development program perceived themselves to be better equipped to become effective health-care leaders as opposed to residents who never, rarely or occasionally participated.

Purpose – This chapter examines the interactions among wholesale betel nut traders within Papua New Guinea’s (PNG’s) flourishing, contemporary, and indigenous betel nut trade. It explores the nature of the “social embeddedness” of the trade and how particular “place-based” practices and ideas shape people’s engagements with markets.Methodology/approach – Multisited ethnographic research focused on betel nut traders.Findings – This chapter highlights how local ideas about sociality and exchange shape the copresent rivalry and companionship that characterize interactions among Mt. Hagen’s betel nut traders. Traders travel long distances and take great risks to buy betel nut. They travel together, share resources, and trade in the same places, and through this they become part of one another’s social networks. This creates the expectation that traders will cooperate, consider other traders in their actions, contribute to each other’s safe-keeping, and act collectively in their interactions with producers. This does not preclude competition, however. Traders compete for profits, but the competiveness of their interactions is also influenced by a concern for status. This copresence of companionship and rivalry, which pervades Hagen sociality more broadly, is central to shaping the trade as a whole.Originality/value of the chapter – Betel nut is the most important domestic cash crop in PNG, and selling betel nut is a prominent livelihood activity for rural and urban people. This chapter reports some of the findings of the first detailed study of the betel nut trade in PNG.