External Direct Sum Invariant Subspace and Decomposition of Coupled Differential-Difference Equations

This article discusses the invariant subspaces that are restricted to be external direct sums. Some existence conditions are presented that facilitate finding such invariant subspaces. This problem is related to the decomposition of coupled differential-difference equations, leading to the possibility of lowering the dimensions of coupled differential-difference equations. As has been well documented, lowering the dimension of coupled differential-difference equations can drastically reduce the computational time needed in stability analysis when a complete quadratic Lyapunov-Krasovskii functional is used. Most known ad hoc methods of reducing the order are special cases of this formulation

p450 APO in Membrane Trajectory 1

The Cytochrome P450 (CYP) enzymes metabolize a variety of drugs, which may potentially lead to toxicity or reduced efficacy when drugs are co-administered. These drug-drug interactions are often manifested by CYP3A4, the most prevalent of all CYP isozymes. We carried out multiple MD simulations employing CAVER to quantify the channels, and Hidden Markov Models (HMM) to characterize the behavior of the gating residues. We discuss channel properties, bottleneck residues with respect to their likelihood to deem the respective channel ingress or egress, gating residues regarding their open or closed states, and channel location relative to the membrane. Channels do not display coordinated motion and randomly transition between different conformations. Gateway residues also behave in a random fashion. Our findings shed light on the equilibrium behavior of the gating residues and channels in the apo state

Introduction of a Spinal Care Pathway Triage Protocol in the Secondary Care Setting

Background: Back pain is considered the leading cause of disability worldwide. Providing effective multidisciplinary care for clients with chronic back pain (CBP) has been an ongoing issue globally. Improper care management of CBP creates personal, economic, and societal burdens that significantly affect patients, their families, and the healthcare system. Purpose: This quality improvement project aimed to successfully integrate a spinal care pathway (SCP) electronic decision support tool (e-tool) into a multidisciplinary spinal care program, to improve providers’ satisfaction with care delivery and their satisfaction with CBP patient outcomes. Methods: This DNP project used an evidence-based quality improvement (EBQI) design to introduce an SCP e-tool into a multidisciplinary spinal care program, a secondary healthcare setting. The Institute for Healthcare Improvements’ Plan-Do-Study-Act cycle was used as the pilot change process to evaluate the effects of an SCP use on CBP patients’ delivery of care and healthcare providers’ satisfaction rates. Results: Of the NSI staff who participated in the surveys, 57.14% agreed, and 42.86% highly agreed that the SCP e-tool is and will be helpful in collaboratively triaging their CBP patients to the most appropriate care modalities to decrease pain and increase functionality, which is a critical metric indicator. (N=7). Conclusion: The SCP e-tool is a novel electronic clinical decision support tool that will provide an evidence-based method to improve the quality and delivery of care for CBP patients. The results of this EBQI project revealed clinical relevance to support the integration of the SCP e-tool into the NSI’s secondary clinical practice setting

Hyperoxemia Education to Nurses to Increase the Adherence to Oxygen Weaning Goals in Inpatient COPD Patients.

Hyperoxemia in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at risk for increased hospital stay, mechanical ventilation, and increased risk of death. Literature supports that establishing increased education to nursing staff on the risks of hypoxemia to increase adherence to oxygen weaning protocols has the potential to improve future practice. Oxygen weaning protocols are often not followed for concern of patient care. Nurses may believe to be helping patients when increasing oxygen, when they could actually be potentially harming them. Increased education on hypoxemia in COPD patients for the nursing staff will assist them to feeling more comfortable following oxygen weaning goals to achieve ordered O2 saturation for their patients. This DNP project focused on evidence based data for hyperoxemia in AECOPD patients with education for nurses to enhance their knowledge. The nurses were presented with an educational poster presentation and a post test to evaluate their hyperoxemia knowledge in AECOPD patients. The educational goal for improvement was to have the nurses to score 80% or higher on the post test. This goal was achieved, implying it was a successful strategy for improvement of knowledge. For future projects in this topic, it would be beneficial to have include a pre and post chart audit to evaluate if the education is being implemented into nursing practice

Art as Experienced by a Female Combat Veteran Using the El Duende Process Painting.

This single-participant phenomenological case study seeks to determine how a female combat veteran experiences art therapy. The case study participant is a female veteran who served in Iraqi Freedom and Enduring Freedom. While painting on a single canvas, the participant followed Miller’s El Duende process painting procedure (2012) and kept a written and pictorial journal of the experience. The research involved five sessions during which the participant annotated her thoughts and feelings on the experiential expressions chart for each session. These charts were analyzed to identify the mechanism of change in art therapy for the participant. The participant’s journals indicated initial tension followed by insight and relaxation by the end of each session, signifying that the process provided a means for emotional release as the veteran explored her inner feelings and memories by painting them into her artwork

Improving Pulmonary Rehabilitation Referral and Uptake for Chronic Obstructive Pulmonary Disorder

Abstract Participation in pulmonary rehabilitation (PR) for patients with Chronic Obstructive Pulmonary Disease (COPD) improves exercise capacity and quality of life and reduces readmissions and mortality. Despite its benefits, PR is underutilized in the treatment of COPD. Referral to PR is impacted by provider knowledge of who and how to refer, the burden of making a referral, the provider’s positive or negative influence and accessibility to a PR program. In contrast uptake of PR by patients is impacted by patient knowledge of what PR entails and how it will help their health. This project aimed to increase referrals to PR at a rural health clinic in Southern Illinois by increasing provider knowledge of what PR entails, improving confidence in who, when and how to refer to PR and improving patient knowledge about PR and how it can improve health. This project equipped providers with materials to use when discussing PR with patients, provided educational posters in examination rooms at the clinic, and measured PR referrals as well as provider’s knowledge and comfort levels in referring COPD patients to PR. The project increased provider confidence in discussing PR and knowing how and when to refer. It is unclear whether the project led to increased referrals to PR. Suggestions for further interventions to improve uptake of PR by COPD patients at this clinic include implementing a prompt in the EHR, annual reassessment and documentation of COPD symptoms, and a post COPD exacerbation bundle. Keywords: Chronic Obstructive Pulmonary Disease COPD, Pulmonary rehabilitation, pulmonary rehabilitation referral, COPD treatment, COPD management, pulmonary rehabilitation benefits

Active Learning Techniques to Improve Emotional Intelligence Among Student Registered Nurse Anesthetists

Students enrolled in nurse anesthesia programs are challenged to meet rigorous and lengthy clinical and didactic requirements throughout doctoral-level curriculums. Historically, admission into nurse anesthesia programs has been based on categories such as academic performance, intensive care nursing experience, and the curriculum vitae. However, emerging research has exhibited emotional intelligence as an essential skill for varying situations that may be encountered. Additionally, training can be utilized to increase emotional intelligence levels (Lolaty et al., 2012). The goal of this doctoral project was to provide emotional intelligence training for first-year student registered nurse anesthetists (SRNAs) at a mid-size University in the Midwestern United States. Project implementation involved a presentation given by an expert in the field of emotional intelligence, followed by two active learning sessions directed by a second-year SRNA, to reiterate concepts from the presentation. Pre- and post-emotional intelligence evaluation scores were obtained via the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) along with subjective data about the training program via a post-implementation survey. Overall, total post- MSCEIT scores showed improvement compared to pre-scores, and survey results revealed positive student feedback. Keywords: emotional intelligence, training, active learning, nurse anesthesia, graduate student