Implementation and Evaluation of a Post-op Coronary Artery Bypass Graft Extubation Checklist to Reduce Prolonged Intubation in the Intensive Care Unit

Background: Total intubation time of post-op coronary artery bypass graft (CABG) patients is set by the Society of Thoracic Surgeons (STS) guidelines. STS states that post-op CABG patients need to be extubated within twelve hours of end anesthesia time with a recommendation of fewer than six hours. The project site had a total intubation time of greater than seventeen hours before removing the outliers. The current process does not result in a total intubation time of fewer than six hours. Implementation of an extubation checklist was chosen as the intervention for this DNP project. Purpose: This DNP project aims to reduce the total intubation time of post-op CABG surgeries closer to the recommended STS guidelines of less than six hours at the project site. Methods: This quality improvement project implemented the use of a post-op CABG extubation checklist. The checklist was designed to follow and simplify the project site\u27s current post-op CABG extubation protocol. Results: Key results included statistical average total intubation time of appropriate patients (Average=4.37 hours). Two Likert scale surveys produced positive results for education and communication. The final result utilized various statistical data and showed improved outcomes in total intubation times. Conclusion: This DNP project found that a post-op CABG extubation checklist with proper nursing education promises to reduce total intubation times. The project found that the checklist was well-received, and 100 percent compliance by nurses on the unit was achieved

Mechanochemical and Combustion Syntheses of Cerium-Doped Lutetium Oxyorthosilicate Powders and Preliminary Studies into the Syntheses of Optically-Active Beta-Germanium(IV) Oxide and Alpha-Quartz Nanoparticles

Lu2SiO5:Ce powders were produced using solvent-free mechanochemistry. The Burgio-Rojac model for the planetary ball mill was used to conduct a parametric study of this synthesis, investigating the effect of varying the powder mass, the vial and ball density, the number of balls, the diameter of the balls, and the rotation rate of the mill on reaction time. The influence of additives was researched with Zn possibly leading to increased reduction of Ce4+ to Ce3+ and with various solvents hindering or preventing Lu2SiO5:Ce production. The solution and gel combustion syntheses of Lu2SiO5:Ce powders were executed using the fuels urea and hexamethylenetetramine both individually and as a mixture. The mixed-fuel solution combustion method successfully produced LSO:Ce powder with excellent replicability. This method produced LSO:Ce powders with a combination of the P 1 21/c 1and C 1 2/c 1 space groups, which were compared to mechanochemically-produce LSO:Ce powders with C 1 2/c 1 symmetry. Lu2SiO5:Ce powders produced by each method were sintered using either a microwave or a furnace. While furnace sintering increased intensity in their photoluminescence excitation and emission spectra, the intensity was decreased with microwave sintering. By furnace sintering the previously microwaved-sintered powder in air, it was determined that oxygen vacancies created during microwave sintering caused the loss of photoluminescence intensities. Preliminary studies were conducted to synthesize optically-active α[alpha]-quartz nanoparticles using optically-active β[beta]-GeO2 nanoparticles as a template. Templating optical activity in β[beta]-GeO2 nanoparticles using L-lysine and (R)-(+)-1,2-diaminopropane as templating agents was attempted. No optical activity was observed in polarimetry and circular dichroism measurements, which was most likely due to insufficient capping agent adsorption. Rac-β[beta]-GeO2 nanoparticles were used to attempt to template α[alpha]-quartz at room temperature as well as when heated in NaOH, NH4OH, Ba(OH)2, and CsOH solutions. α[alpha]-Quartz did not form in any powders although the silica may have dissolved during the heating

Effectiveness of Resin Infiltration and Mi Paste Cpp-Acp in Masking White Spot Lesions

The development of decalcification around orthodontic brackets and bands, commonly called white spot lesions (WSLs), is often observed in patients with poor oral hygiene during treatment (Behnan et al., 2010, Rodgers et al., 2010). In many instances, these WSLs continue to be visible after the removal of fixed appliances and after natural remineralization. The purpose of this in vitro study was to compare the effectiveness of two treatment modalities, resin infiltration (RI) and Casein Phosphopeptide Amorphous Calcium Phosphate (CPP-ACP), at improving the light reflectivity and thus the appearance of WSLs using spectrophotometric analysis. Sixty extracted human third molars were partially demineralized to create artificial WSLs and randomly divided into a control (artificial saliva) and two treatment groups. A spectrophotometer (VITA Easyshade® compact) was used before and after treatment to quantify the amount of light (L*) reflected from the surfaces of each tooth specimen. All three groups showed statistically significant improvements in reflectivity, as indicated by the increase in L* after treatment. However, there were no statistically significant differences among the study groups. In conclusion, both treatment modalities and the control were effective at masking WSLs

The Plains of Mars, European War Prints, 1500-1825

Over fifty original prints by renowned artists from the sixteenth through the early nineteenth century, including Albrecht Dürer, Lucas Cranach, Théodore Géricault, and Francisco de Goya, among many others, are featured inThe Plains of Mars: European War Prints, 1500-1825. On loan from the Sarah Campbell Blaffer Foundation at the Museum of Fine Arts, Houston, the works of art included in this exhibition examine the topics of war and peace, propaganda, heroism, brutal conflicts, and the harrowing aftermath of battle. Spanning from the Renaissance to the Romantic periods and encompassing a wide geographic scope including Italy, Germany, France, Spain, the Low Countries, England, and North America, the prints depict triumphant Renaissance soldiers, devastating scenes of violence, and satirical caricatures of political figures. Also on display is Goya’s compelling “Disasters of War” series, completed in response to the brutality of the Spanish War of Independence. Goya’s prints serve as a powerful testament to the horrors faced by both soldiers and civilians. Under the direction of Professor Felicia Else and Shannon Egan, Melissa Casale ‘19 and Bailey Harper ‘19 have researched and written didactic labels, catalogue essays, and created an interactive digital interface to complement the exhibition. Together, Melissa and Bailey will lead public tours of the exhibition. A Gallery Talk by Prof. Peter Carmichael will draw connections between the depictions of warfare on view in the Gallery with representations of the American Civil War. James Clifton, Director of the Sarah Campbell Blaffer Foundation at the Museum of Fine Arts, Houston, will be delivering a lecture in conjunction with the exhibition. Dr. Clifton, who also serves as curator of Renaissance and Baroque painting at MFAH, curated the exhibition in its first iteration and wrote the exhibition catalogue (published by Yale University Press). Dr. Clifton’s lecture not only will provide an overview of the exhibition, but also will focus on the concept of “mediated war.” A full-color catalogue with images and essays by Bailey Harper ’19 and Melissa Casale ’19, under the supervision of Profs. Felicia Else and Shannon Egan, is planned to accompany the exhibition.https://cupola.gettysburg.edu/artcatalogs/1028/thumbnail.jp

Domestic Violence, Cognition and the Church

Recognizing and building upon the advances the church has made, regarding raising awareness of DV as a problem for our members and our congregations, this session will utilize a cognitive model to inform next steps to inform behavioral change efforts. A multi-step model, building on current change efforts in our churches and communities, will be discussed

The influence of parental health beliefs on child restraint practices in a regional centre in Queensland

Since March 2010 in Queensland, legislation has specified the type of restraint and seating row for child passengers under 7 years according to age. The following study explored regional parents’ child restraint practices and the influence of their health beliefs over these. A brief intercept interview was verbally administered to a convenience sample of parent-drivers (n = 123) in Toowoomba in February 2010, after the announcement of changes to legislation but prior to enforcement. Parents who agreed to be followed-up were then reinterviewed after the enforcement (May-June 2010). The Health Beliefs Model was used to gauge beliefs about susceptibility to crashing, children being injured in a crash, and likely severity of injuries. Self-efficacy and perceptions about barriers to, and benefits of, using age-appropriate restraints with children, were also assessed. Results: There were very high levels of rear seating reported for children (initial interview 91%; follow-up 100%). Dedicated child restraint use was 96.9% at initial interview, though 11% were deemed inappropriate for the child’s age. Self-reported restraint practices for children under 7 were used to categorise parental practices into ‘Appropriate’ (all children in age-appropriate restraint and rear seat) or ‘Inappropriate’ (≥1 child inappropriately restrained). 94% of parents were aware of the legislation, but only around one third gave accurate descriptions of the requirements. However, 89% of parents were deemed to have ‘Appropriate’ restraint practices. Parents with ‘Inappropriate’ practices were significantly more likely than those with ‘Appropriate’ practices to disagree that child restraints provide better protection for children in a crash than adult seatbelts. For self-efficacy, parents with ‘Appropriate’ practices were more likely than those with ‘Inappropriate’ practices to report being ‘completely confident’ about installing child restraints. The results suggest that efforts to increase the level of appropriate restraint should attempt to better inform them about the superior protection offered by child restraints compared with seat belts for children

Hemorrhagic stroke: a diagnosis guided by visual field findings

This case report outlines a patient with a hemorrhagic stroke who presented to the eye clinic with visual field loss, which the patient interpreted as blur, and a severe headache. The visual field loss consisted of an incomplete homonymous hemianopsia with an absolute superior defect, which corresponds well to the right sided temporal lobe hemorrhage found on head computed tomography (CT) scan. This case highlights the importance of all eye care providers recognizing stroke symptoms and understanding referral timelines and protocols as well as the high predictive value of visual fields

AVC hémorragique : diagnostic guidé par les résultats du champ visuel

Ce rapport de cas porte sur un patient qui a subi un accident vasculaire cérébral hémorragique et qui s’est présenté au service de consultations ophtalmologiques avec une perte de champ visuel, que le patient a interprétée comme un trouble de la vue et un mal de tête grave. La perte de champ visuel a consisté en une hémianopsie incomplète homonyme accompagnée d’une défectuosité supérieure absolue qui correspondait bien à l’hémorragie du lobe temporal droit détectée par une tomodensitométrie de la tête. Ce cas expose l’importance pour tous les fournisseurs de soins oculovisuels de reconnaître les symptômes de l’AVC et de comprendre les délais et les protocoles de référence, ainsi que la valeur prédictive élevée des champs visuels

Undoing the Dyad: Re-examining Mentorship with a Feminist Lens

Academic libraries consistently use mentoring programs to integrate new employees by sharing organizational knowledge and providing support to advance in their careers. Traditional models of mentorship are tools that help support existing power structures and keep in power those benefiting from the associated privilege. One way to interrogate traditional mentorship models and their inherent inequities is to apply a feminist lens in examining the expectations and actions of mentors and mentees. This chapter discusses how the traditional dyad mentoring model does not support everyone equally and explores alternative, inclusive models of mentorship, such as group mentoring and peer mentoring. We will connect historical context and theoretical models of mentorship with our own experiences through a feminist lens. Our goal is to highlight models that acknowledge the psychosocial aspect of mentorship, celebrate diverse identities and experiences, and seek to balance power structures