Civic Community: Online Communities of Practice in Parkland

While urbanization continues apace in Western states, people are also relocating to the fringes of both the urban and rural landscape to a sort of middle ground mixture of urban, suburban and rural. This diversity expands beyond just geography to culture, income level, education level and race.. It is in these middle areas that homelessness, drugs, crime, and a need for community all exist. This study examines a little of how one community, Parkland, Washington, came to be one of these middle areas. Like many other areas similar to Parkland there has been an influx of people over the last decade and with it there has been very little help from the city or the state to address the issues that arise. There are three food banks and a traveling ministry that delivers food to those who are housebound. There is no dedicated police department or sub station, homeless shelter, resources centers, fire station or place to get resources or help. The social media of online communities of practice (OCPG) can facilitate the creation of an online civic community whose benefits extend beyond the individuals and their online group to the entirety of the geographically bound area of their group. This can increase both the breadth and depth of a civic community. This study helps contribute to our understanding of the way in which OCPGs provide connections in a physically bound community. Social cohesion and civic engagement were observed while monitoring the different online groups. The results of this are a stronger and more effective civic community. Through the observation It was also noticed that on some occasions the benefits of social cohesion and civic engagement extend beyond both the OCPGs members and the community of Parkland

Preoperative Education: Changing Patient Perceptions and Expectations One Spine at a Time

In the surgical spine population, fear of the surgical experience as well as the potential for postoperative pain is often a source of significant distress which can influence postoperative expectations and overall patient satisfaction. Patient education and defining postoperative pain expectations are valuable and affordable alternatives to the rising costs, both fiscal and personal, associated with our national reliance on opioids as the primary strategy for postoperative pain management. Although there is significant literature on the efficacy of preoperative education classes in the orthopedic population, the efficacy of preoperative education classes for surgical spine patients including their effect on pain perceptions and postoperative expectations has not been widely examined. We hypothesized that preoperative education targeting postoperative pain expectations and pain management strategies would improve the patients\u27 perception of postoperative pain and thus their overall experience. Standardized preoperative education was developed and offered through in-person classes held twice weekly at our main hospital and once monthly at a rural location, and through an online video link. A prospective cross-sectional, non-experimental study design was conducted with data collection occurring through preoperative and postoperative patient questionnaires. Over the course of a 9 month period, a total of 350 postoperative spinal surgery patients were enrolled in the study. Of the participants enrolled, 133 patients participated in the preoperative education offerings. The 212 patients who did not participate in preoperative education expressed a “better than expected level of pain” after surgery. The reality of their operative experience was that their fears, anxieties, and pain were less than they had anticipated. The majority of patients who received the education expressed that their postoperative pain level was “as expected.” Additionally a greater number of participants who received the educational offerings reported a history of chronic pain. The majority of participants noted that the video and the in-person educational sessions were helpful in preparing them for surgery. Preoperative education can be an effective tool to reduce patients’ fears and anxiety related to the surgical experience by acknowledging and discussing those fears and anxieties and by setting realistic expectations of postoperative pain and management strategies.https://scholarlycommons.libraryinfo.bhs.org/nursing_artof_innovation/1021/thumbnail.jp

Navigating Neurosurgical Pain

https://scholarlycommons.libraryinfo.bhs.org/nursing_artof_answering/1015/thumbnail.jp

On the Nature of AGN and Star Formation Enhancement in the z = 3.1 SSA22 Protocluster: The HST WFC3 IR View

We examine possible environmental sources of the enhanced star formation and active galactic nucleus (AGN) activity in the z = 3.09 SSA22 protocluster using Hubble WFC3 F160W (∼1.6 μm) observations of the SSA22 field, including new observations centered on eight X-ray selected protocluster AGN. To investigate the role of mergers in the observed AGN and star formation enhancement, we apply both quantitative (Sérsic-fit and Gini–M20) and visual morphological classifications to F160W images of protocluster Lyman-break galaxies (LBGs) in the fields of the X-ray AGN and z ∼ 3 field LBGs in SSA22 and GOODS-N. We find no statistically significant differences between the morphologies and merger fractions of protocluster and field LBGs, though we are limited by small number statistics in the protocluster. We also fit the UV-to-near-IR spectral energy distributions of F160W-detected protocluster and field LBGs to characterize their stellar masses and star formation histories. We find that the mean protocluster LBG is a factor of ∼2 times more massive and more attenuated than the mean z ∼ 3 field LBG. We take our results to suggest that ongoing mergers are not more common among protocluster LBGs than field LBGs, though protocluster LBGs appear to be more massive. We speculate that the larger mass of the protocluster LBGs contributes to the enhancement of SMBH mass and accretion rate in the protocluster, which in turn drives the observed protocluster AGN enhancement

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease