Optimizing Sepsis Management Through Enhanced Protocol Compliance in the Emergency Department

Problem: With a recent influx of sepsis cases, hospital stakeholders identified gaps between sepsis protocol and practice. This quality improvement project aimed to increase sepsis bundle compliance and utilization among registered nursing staff in the emergency department to improve sepsis management and patient outcomes ultimately. Context: The microsystem assessed is a 44-bed emergency department at Hospital A, a level II adult trauma center within the greater San Francisco Bay Area. The current registered nurse roster within this department, excluding four on leave, is 115 individuals and represents the target population for this change project. Interventions: Interventions were not implemented due to project time constraints. However, proposed recommendations were presented to unit leadership for future implementation. Suggested interventions would standardize the sepsis screening policy, escalation pathways, and training opportunities as well as increase unit signage with visual aids which detail sepsis guidelines. Measures: Data collection and microsystem assessments sought to measure current sepsis protocol compliance for this change project. Post-intervention sepsis bundle adherence remains the primary metric to evaluate the effectiveness of quality improvement initiatives going forward. Results: Pre-intervention questionnaire results revealed discrepancies in staff training frequency, chain of command, and leadership follow-up on near misses and fallout cases. The microsystem’s unpredictable patient volume presented barriers to timely sepsis management. Post-intervention results remain inconclusive and outside of this project’s allotted time frame. Conclusions: Analysis of gaps in sepsis bundle compliance revealed multiple causative factors that delay sepsis care within the emergency department. Proposed interventions sought to increase standardization and collaboration in the unit to improve bundle compliance. Project continuation is necessary to implement proposed recommendations and study their effectiveness in enhancing sepsis bundle compliance rates

An Exploratory Investigation of Teacher Perceptions of Education and Communication at the Beginning of the COVID-19 Pandemic

In March 2020, teachers in the K–12 school system were forced to transition from in-person instruction to a variety of virtual teaching models due to the COVID-19 pandemic. This unprecedented change required extensive communication between teachers, students, parents, and administrators. This study explored communication during the March–May 2020 transition period, utilizing Uncertainty Management Theory as an overarching framework to investigate how teacher comfort with online learning, communication overload, administrative clarity, and student–teacher interaction influenced the effectiveness and happiness of teachers. Across these four variables, communication overload was shown to be a strong negative predictor of teacher well-being; student–teacher interaction predicted positive teaching outcomes

Ionized Gas Motions and the Structure of Feedback Near a Forming Globular Cluster in NGC 5253

We observed Brackett $\alpha$ 4.05$\mu$m emission towards the supernebula in NGC 5253 with NIRSPEC on Keck II in adaptive optics mode, NIRSPAO, to probe feedback from its exciting embedded super star cluster (SSC). NIRSPEC's Slit-Viewing Camera was simultaneously used to image the K-band continuum at $\sim$$0.1''$ resolution. We register the IR continuum with HST imaging, and find that the visible clusters are offset from the K-band peak, which coincides with the Br $\alpha$ peak of the supernebula and its associated molecular cloud. The spectra of the supernebula exhibit Br $\alpha$ emission with a strong, narrow core. The linewidths are 65-76 km s$^{-1}$, FWHM, comparable to those around individual ultra-compact HII regions within our Galaxy. A weak, broad (FWHM$\simeq$150-175 km s$^{-1}$) component is detected on the base of the line, which could trace a population of sources with high-velocity winds. The core velocity of Br $\alpha$ emission shifts by +13 km s$^{-1}$ from NE to SW across the supernebula, possibly indicating a bipolar outflow from an embedded object, or linked to a foreground redshifted gas filament. The results can be explained if the supernebula comprises thousands of ionized wind regions around individual massive stars, stalled in their expansion due to critical radiative cooling and unable to merge to drive a coherent cluster wind. Based on the absence of an outflow with large mass loss, we conclude that feedback is currently ineffective at dispersing gas, and the SSC retains enriched material out of which it may continue to form stars.Comment: 24 pages, 9 figure

Adjust-A-Ramp

Adjust-A-Ramp is a portable ramp designed to ensure the safety of consumers and prevention of damage to cars, specifically towards low profile cars. A low-profile vehicle includes any vehicle that has a clearance off the ground of 6.5 inches or less. Advantages of low-profile vehicles include improved handling, better braking, increased fuel efficiency, increased stability, and an overall luxury aesthetic. The reduced tire size increases grip on smooth surfaces with better wheel response, creating a fast, more efficient ride. The simple tire tread patterns and the stiff sidewalls allow for lower rolling resistance which increases fuel economy. The Adjust-A-Ramp can be used professionally by shops or through personal, at-home use of the consumer. This product would be the only safe, low-profile capable, and functionally customizable car ramp in comparison to the current market options

Development of Chondroinductive Hydrogel Pastes from Naturally Derived Cartilage Matrix

The main focus of hydrogel technology is on hydrogels in their crosslinked form. Although hydrogels are promising materials for cartilage tissue engineering, the clinical translation of these materials are hindered because they lack the ability to be molded into a defect site by a surgeon due to hydrogel precursors being liquid solutions that are prone to leaking from the implantation site during placement. Therefore, the current thesis work focuses on the hydrogels in their precursor form prior to crosslinking and describes the development of creating hydrogel pastes that have the potential to be clinically translatable. The current thesis first developed a platform hydrogel paste composed of methacrylated hyaluronic acid (MeHA), which is a more traditional hydrogel material, and hyaluronic acid nanoparticles. The hyaluronic acid nanoparticles were shown to impart a yield stress on the hydrogel precursors, allowing the precursors to be molded and shaped prior to crosslinking. Furthermore, the mixtures containing hyaluronic acid nanoparticles were able to be crosslinked and further characterized as solids and they could encapsulate bone marrow-derived stem cells that remained viable. The next major focus of the thesis was tailoring the platform system for cartilage tissue specifically, by gradually replacing each of the two components of the platform system with naturally derived cartilage extracellular matrix, to create a chondroinductive material. Devitalized (DVC) and decellularized cartilage (DCC) particles were found to impart paste-like behavior in MeHA gels, where DVC significantly upregulated chondrogenic gene expression. DCC that was solubilized and methacrylated (MeSDCC) was created and crosslinked, which formed hydrogels with a compressive modulus in the range of native cartilage tissue. Finally, DVC particles mixed in with solubilized and methacrylated DVC created pastes that significantly upregulated chondrogenic gene expression compared to gels without DVC particles. The important next steps will be to further evaluate these MeSDVC and DVC particle pastes in an in vivo model, and further explore whether decellularization of the tissue is necessary. Ultimately, this thesis successfully developed a hydrogel paste that is inherently chondroinductive and promising for future cartilage tissue engineering applications

Immigration and Belonging: Chinese Immigration to Argentina 论阿根廷中国移民的归属感及身份认同

This research set out to answer the question: How do Chinese immigrants to Argentina form a sense of belonging? This research was initially carried out through bibliographic research and then through two weeks of ethnographic field research in Buenos Aires, Argentina which included participant observation as well as formal and informal semi- structured interviews. A broad understanding of Chinese immigrants’ life experiences was garnered through hearing their personal stories. Chinese immigrants’ experiences overlapped in one main way: all are considered foreign by some of the non-Chinese people around them. However, even accounting for this similarity, the most notable finding was that while Chinese-to-Argentina immigrants’ stories might have had overlapping parts, no two people’s stories were the same and a comprehensive study of immigrant identity formation requires a deep look into each person’s unique experience

Place Removed: A Study of Authenticity in Remote Locations

Richmond, Virginia has, through recent design proposals and projects, sought reconciliation with the countries in West Africa that were once the source for slave trade in which the city was such an active participant. These admirable works address the nations’ shared history, perhaps at the expense of understanding modern cultures. This thesis seeks to create this understanding through the development of an educational facility that would interact with Richmond’s current landscape. In pursuit of respectful relationship, I address the ways in which design can authentically teach about place. The study begins with the creation of a personal understanding of site through diagrammatic analysis. The research continues with case studies that relate to either the context, program or process of this project. The concepts this research generated led to a proposed design solution for the Southern Railway Freight building in Richmond’s Shockhoe Slip. Both design processes and the proposed solution are documented herein

COVID-19 Testing and Education at the Allen Family Center

COVID-19 Testing and Education at the Allen Family Center COVID-19 Testing and Education at the Allen Family Center The Mount Baker community is home to many families experiencing homelessness and housing instability. According to the Department of Community and Health Services, there is an estimate of 40,800 people in King County who experienced homelessness in 2020 (King County Department of Community, 2021). The Allen Family Center (AFC) is an inviting community resource, partnered with Mary’s Place and Mercy Housing Northwest, that serves families by providing assistance with housing, medical care, and childcare; recently, the AFC began providing COVID-19 testing available to anyone in the Mount Baker community. After assessing the AFC, our group, which consists of Seattle Pacific University (SPU) nursing students, determined that the AFC staff would benefit from further education regarding COVID-19 testing. Our goal for this project was for the AFC and its staff to be well-equipped with the skills and knowledge to operate a COVID-19 testing location for the surrounding Mount Baker community. Background Throughout the COVID-19 pandemic, there has been an increase in people experiencing homelessness and therefore an increased need for easily accessible COVID-19 testing (King County Department of Health, 2022). According to the King County Department of Health, the homeless population is at a higher risk of becoming infected with COVID-19 and experiencing severe illness related to COVID-19 (King County Department of Health, 2022). Fortunately, the AFC was provided with a large number of Binax COVID-19 testing kits for use in the Mount Baker community. However, the knowledge deficit within the AFC staff regarding safe COVID-19 testing protocol and infection prevention was a barrier to their confidence in facilitating safe COVID-19 testing. In addition to the knowledge deficit, the AFC is also limited in its ability to function fully due to setbacks related to COVID-19. Activities Our project consisted of reviewing current COVID-19 literature and testing protocols in order to create an educational binder for staff and clients. Our initial windshield survey of the AFC revealed the need to tailor the existing Mary’s Place testing protocols to their unique space. These modifications included a streamlined and comprehensive screening tool, adjustments to the Mary’s Place protocol, and details on safe donning and doffing of personal protective equipment (PPE). Our symptom screening tool was developed using the Centers for Disease Control and Prevention (CDC) as a reference with the intention of being simple and comprehensive (CDC, 2020). We included questions relevant for the AFC such as the clients race, ethnicity, and if they were pregnant. For the modified Mary’s Place protocol, we included details on the use of the AFC space and specific testing procedures for the staff to follow. Finally, we provided educational infographics and links to videos regarding PPE donning and doffing; staff were educated to perform hand hygiene, wear a mask, and don gloves in order to promote staff safety. These three elements comprise the core of our project and final deliverables. One of our nursing diagnoses was a staff knowledge deficit regarding COVID-19 testing protocols and safety surrounding hand hygiene, disinfection, and testing flow. This led us to review research around proper testing protocols, sanitation, donning and doffing of PPE, and proper waste disposal to educate staff. We also compiled resources for the surrounding community such as sick day protocols, a vaccine locator, and additional locations to obtain a COVID-19 polymerase chain reaction (PCR) test. After a review of the research, we compiled relevant information into a binder and digital folder intended for use and distribution by the AFC staff. We met with the AFC staff in person to deliver these elements, assess their current testing protocol, and review our planned protocol. At this point, we were able to demonstrate all the necessary education we gathered. Meeting face-to-face provided the opportunity to answer questions directly, collaborate and brainstorm with staff on final edits to the protocol, and demonstrate any hands-on techniques, such as properly donning and doffing gloves. 4 Ultimately, these resources are intended for ongoing use to protect the health and safety of staff and the community they serve. Outcomes Our first outcome goal was to improve staff knowledge of safe COVID-19 testing practices. A limitation to this was the complexity and number of steps required to complete safe and effective COVID-19 testing. To avoid this limitation, we provided a step-by-step document explaining the testing procedures for each person involved in the testing process (See appendix). After visiting the AFC and providing in-person staff training, we found that our goal was met when the staff was able to explain and perform the testing process accurately. The second outcome we achieved was updating the AFC COVID-19 testing protocol to be current with the CDC guidelines for testing. Mary’s Place provided their established protocol for COVID-19 testing. We realized their protocol would need to be adapted to the AFC. We utilized the most up-to-date CDC information in order to update the protocol and make it specific to the AFC. A major limitation to this is the ever-changing nature of COVID-19 protocol as new information comes to light. To combat this limitation, we opted to provide a digital copy of our resources so as information is updated, the AFC can remain equipped with the most current information directly from the provided sources. The final outcome we hoped to achieve is an increased access to efficient, safe testing for the Mount Baker community. At this time, the AFC is testing their staff weekly and any clients who walk up to the building requesting COVID-19 testing. While we were able to meet this goal by facilitating the agency to open a new testing site at the AFC, we recognize that there is a limitation in how many clients can be tested due to COVID-19’s impact on the AFC’s ability to function at full capacity. As the pandemic settles, our hope is that the resources provided to the AFC will be sufficient to support their testing process and reach the greater Mount Baker community. Conclusion The newly established AFC in Mount Baker, Seattle has been providing COVID-19 testing to their staff and the greater community. The staff voiced their concerns about their knowledge deficit related to best practice protocol to keep themselves and clients safe and healthy. To best support both the staff and the Mount Baker community, SPU nursing students developed an evidence-based COVID-19 testing protocol for the AFC and provided educational materials and training. Through these interventions, we equipped the AFC staff with the education needed to facilitate a functioning and safe COVID-19 testing site. The AFC staff reported feeling empowered with the knowledge and confidence to carry out COVID-19 testing in a community facing a higher risk of exposure. A limitation to our project is the short timeline we were granted to work with the AFC because it limits our ability to see the long-term impact of our interventions. Our work to empower the staff with educational material and safe testing protocol proved to be valuable to those we worked with at the AFC and surrounding community. Seeing the staff react positively to our interventions and deliverables proved that establishing a safe and functioning testing site positively affected the community by leading to increased access to testing, community awareness, and improved staff knowledge. References CDC. (2020, June 29). CDC Facilities COVID-19 Screening. Centers for Disease Control and Prevention. https://www.cdc.gov/screening/index.html King County Department of Community and Human Services. (2021). Integrating data to better measure homelessness [Infographic]. Kingcounty.gov. https://kingcounty.gov/~/media/depts/communityhumanservices/department/documents/KC_DCHS_Cross_Systems_Homelessness_Analysis_Brief_12_16_2021_FINAL.ashx?1 King County Department of Health. (2022, January). Homelessness and Covid-19. Homelessness and COVID-19 - King County. Retrieved February 23, 2022, from https://kingcounty.gov/depts/health/covid-19/data/homeless.asp

Landscape Values and Aesthetic Preferences Across the Front Range

Boulder’s Open Space and Mountain Parks (OSMP) lands are managed to provide a diverse set of benefits valued by Boulder’s residents as well as tourists. Not all OSMP lands provide the same set of benefits however. Understanding how the values associated with OSMP lands vary across the region can provide managers with insights into how best to allocate resources so that they yield the maximum public benefit. In addition to an understanding of the values visitors associate with OSMP lands, management can benefit from knowledge of how different features of the landscape impact user experiences, both positively and negatively

Aesthetic Characteristics of the Front Range: An Analysis of Viewsheds Provided by Boulder OSMP Lands

The city of Boulder’s Open Space and Mountain Parks (OSMP) lands offer residents and visitors a variety of unique recreational, scenic, and cultural experiences that are often captured and shared publicly via social media. Given the diversity of OSMP lands, visitor experiences likely differ based on the aesthetic and biophysical features that can be viewed from these landscapes. For instance, the peaks of the iconic Flatirons provide visitors with different scenic views than the low-lying grasslands in the southeastern area of the city. Furthermore, visitor use and enjoyment of OSMP lands could be directly related to the landscape features that are visible from these different locations. Understanding how visible landscape features vary across OSMP lands can help managers target their planning efforts to improve the quality of outdoor recreation experiences, and potentially identify new locations for outdoor recreation infrastructure (e.g., trails, pavilions, etc.) that offer the ability to see the regions most desirable landscape features. This study: (1) identifies points in the landscape where users are often inspired to take photographs; (2) maps the landscapes most often viewed by visitors; (3) summarizes the types of landscape features viewed from OSMP lands; and (4) determines how these landscape features vary across LCAs