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Convergence-retraction nystagmus in Parinaud\u27s syndrome
No full textDorsal midbrain (Parinaud\u27s) syndrome often consists of upgaze paresis, convergence-retraction nystagmus (CRN), pupillary light-near dissociated, and eyelid retraction. Patients may have a selective upward saccade palsy with sparing of upward pursuit and the vestibulo-ocular reflex, or the inability to make any upward movements. When patients are asked to look up, instead of an upward saccade, the eyes may converge, relax, converge, etc. These alternating convergent-divergent movements give the appearance of nystagmus, even though it is not technically nystagmus. This is probably another manifestation of disinhibited or overactive convergence, and if the globes are viewed from the side, a retraction into the orbits can be seen due to co-contraction of extraocular muscles. An optokinetic stimulus (e.g., drum or flag) is a convenient way to visualize the CRN because it will occur with each (attempted) under quick phase. This patient had a history of craniopharyngioma and hydrocephalus, which are etiologies that can cause external compression of the dorsal midbrain and posterior commissure. There was also light-near dissociation and eyelid retraction was also noted acutely, but improved with time. The left eye is being occluded in this video due to a longstanding (unrelated) large angle comitant exotropia, to ensure that the strabismus did not interfere with the finding of CRN
Bus stop improvement: attribute data update and analysis
No full textposterSince 2017, Utah Transit Authority has been making strides in bus stop improvement. UTA stop improvement operates under the guidance of the Bus Stop Master Plan (BSMP). The plan outlines bus stop design and amenities, and assigns Level Improvement based on ridership
Adrian interview transcript
No full textTAGLINE: Adrian, a Chihuahua migrant who came to the; US as a child reflects on his journey from Villa Juarez; Chihuahua to Texas to Utah and expresses how he; continues to work for a better life for his family and; himsel
Overcoming Barriers to Breaks for Nurses on 12-Hour Shifts
No full textThe purpose of this project was to conduct a needs assessment and develop a strategic plan to overcome barriers to adequate restorative breaks and to entrench break-taking practices for nursing staff in a cardiac unit. Rationale/Background: Burnout reduces job satisfaction, increases the financial burden on organizations, and results in poor patient outcomes. One factor that drives burnout is the lack of opportunities to take regular, rejuvenating breaks during long shifts. Methods: Using surveys and time clock data, a needs assessment was conducted for a single hospital unit to determine the frequency and reasons why nursing staff did not receive breaks. Next, key issues were identified and addressed through practical recommendations from evidence-based literature in the form of a strategic plan. Results: Of the 58 staff members, 66% said they only took one break during a 12-hour shift, while 12% reported skipping breaks entirely. Barriers to break-taking included high patient loads (72%), staffing shortages (33%), administrative duties (40%), and a physical environment not conducive to breaks (44%). Free-text survey responses identified additional issues. Based on these findings, the components of the strategic plan included: 1) implementing a structured break system, 2) fostering a supportive workplace culture, 3) improving the physical space where breaks occur, and 4) increasing awareness of formal break policies. Conclusions: This project identified barriers preventing nursing staff from taking breaks, and developed a strategic plan to mitigate these concerns. The unit can implement this plan to support break opportunities, potentially leading to reduced burnout, improved staff well-being, and positive patient outcomes