Comparison of two methods for estimating the tip position of a nasogastric feeding tube : a randomized controlled trial

Background Several studies have shown that the nose‐earlobe‐xiphoid distance (NEX) is inadequate to estimate the insertion length of nasogastric tubes. An alternative approach tested in these studies, which leads to > 90% well‐placed nasogastric tubes, used a corrected calculation of the NEX: (NEX × 0.38696) + 30.37. The primary aim of this study was to determine whether using the corrected NEX was more successful than the NEX in determining the insertion length. The secondary aim was to investigate the likelihood to successfully obtain gastric aspirate. Methods Adult patients in a general hospital (N = 215) needing a nasogastric tube were randomized to the control (NEX) or intervention group (corrected NEX). Tip positioning was verified using X‐ray. Correct tip positioning was defined as between 3 and 10 cm under the lower esophageal sphincter (LES). Results In >20% of all patients, both methods underestimated the required tube length for correct positioning. The NEX showed an overestimation (17.2%) of the insertion length (>10 cm under the LES) compared with the corrected NEX (4.8%). There was no difference (P = 0.938) between the 2 groups in obtaining gastric aspirate (55.6% vs 56%). However, correct tip positioning resulted in a fourfold increase of obtaining gastric aspirate. Conclusions Both methods resulted in a high risk of incorrectly placed tubes due to malposition of the tip near the LES or distal esophagus. This may increase the risk of reflux and pulmonary aspiration. Based on these results, the development of more reliable methods requires consideration.status: publishe

The Distribution of Type 1 Diabetes Onset in the United States by Demographic Factors

Type 1 diabetes (T1D) is a chronic and lifelong condition, often diagnosed in childhood. Patients with T1D are at elevated risks of associated health complications, comorbidities, and mortality. Occurrence, clinical presentation, and complications related to T1D differ by age of onset, ethnicity, and gender. The last reported population-based estimates regarding the burden of T1D in children using the National Health and Nutrition Examination Survey (NHANES) were published in 2008, and these estimates were not well stratified by age of onset, ethnicity, and gender. The purpose of this study was to examine these demographics within the conceptual framework of the hygiene hypothesis using data from NHANES from 1999 to 2012. A cross-sectional study design was used to determine the average age of onset of T1D with respect to ethnicity and gender and to assess if age of onset is associated with ethnicity and gender. The average age of onset was 10.5 years for males and 11.8 years for females. The average age of onset was 13.0 years for Hispanics, 12.7 years for Non-Hispanic Blacks, and 10.6 years for Non-Hispanic Whites. Regression analysis indicated that there was no significant association between age of onset and gender (β = 1.1, p = 0.386) and between age of onset and ethnicity (β= 2.1, p = 0.070 for Hispanic White; β = 1.9, p = 0.101 for Non-Hispanic Black) having considered the Non-Hispanic White as the reference population. The result of this study may contribute to positive social change by providing better insight on demographic determinants of the risk of T1D, which is crucially important in the planning and implementation of prevention measures in highly susceptible populations

Gregory Corso

Gregory Nunzio Corso - referred to as the Urban Shelley of the Beat Generation - lived a life as explosive and controversial as his poetry. Growing up in Greenwich Village, New York, his youth consisted of foster homes, prison, and a brief stay in Bellevue Psychiatric ward. In his twenties, he moved to Paris, France, and founded the Beat Hotel in 1957. While there, he published his poetry through correspondence with City Lights Books in San Francisco via Lawrence Ferlinghetti. His most memorable poem Bomb was written in 1958 and provoked mixed reviews when first read in England. Corso was the most Eurocentric of the Beat poets. Living a waif life, he traveling around Europe and the United States, never truly settling down. He was married three times and had five children. In the last thirty years of Corso\u27s life, he slowly retreated into solitude and drugs. He lived his last months in Robbinsdale, Minnesota, where he passed away of prostate cancer at the age of seventy.https://digitalcommons.usu.edu/beat_exhibit/1006/thumbnail.jp

Remembering as Resurrection: Transgenerational Trauma and Memory in J.K. Rowlings Harry Potter Series

What does it mean to bear witness to the memories of previous generations’ trauma victims? What lessons should we learn from those who came before us to ensure a happier future? This thesis explores the trauma and memories of the deceased or older generation found in J.K. Rowling’s Harry Potter series. I intend to analyze the character of Harry Potter as he interacts with the memories of the previous generation, which he is able to resurrect in embodied forms through the use of magic. By testifying to the memories of the previous generations’ trauma, Harry is able to break the cycle of violence and create a seemingly happy ending to his life’s story. Through critically studying Harry Potter as a transgenerational narrative, readers are able to learn how to bear witness to the memories of those with whom they associate in their own live and create a more empathetically inclined world

Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal: a qualitative study.

Aim and objectives. To explore the experiences of intensive care nurses who provided end-of-life care to adult patients and their families after a decision had been taken to withdraw treatment. Background. End-of-life care following treatment withdrawal is a common phenomenon in intensive care. Less is known about nurses’ experiences of providing care for the dying patient and their family in this context, when compared to specialist palliative care. Design. Descriptive exploratory qualitative study. Methods. A purposive sample of 13 intensive care nurses participated in a semi-structured face-to-face interview. Transcribed data was analysed using the principles of interpretative phenomenological analysis. Results. The essence of nurses’ experiences of providing end-of-life care after the withdrawal of treatment was interpreted as doing the best to facilitate a comfortable and dignified death’. Four master themes included: caring for the dying patient and their family; providing and encouraging presence; reconnecting the patient and family; and dealing with emotions and ambiguity. Uncertainties were evident on processes and actions involved in treatment withdrawal, how to reconnect patients and their family effectively and how to reduce the technological environment. Conclusions. Providing end-of-life care after a decision has been taken to withdraw treatment was a common aspect of intensive care. It was evident that nurses were doing their utmost to support patients and families at the end of life, despite the multiple challenges they faced. Relevance to clinical practice. The interpretive findings from this study should assist intensive care unit nurses to better understand and develop their role in providing high-quality end-of-life care after treatment withdrawal. Practice guidelines should be developed to reduce ambiguity and support the delivery of high-quality care for adults as they approach the final stages of life in intensive care units

Recommendations, Rhetoric, and Reporting: State and NGO Behavior in the Universal Periodic Review of Human Rights

This dissertation takes a detailed look at the role of non-state stakeholders, overwhelmingly civil society non-governmental organizations (CSOs or NGOs), in human rights promotion within the process of the United Nations Human Rights Council\u27s Universal Periodic Review of Human Rights. Utilizing a mixed-method, text-heavy approach, I conduct analyses of both state behavior and NGO activity within the first cycle of the Universal Periodic Review of Human Rights and examine the monitoring and follow-up practices between review rounds through paired cases in the second round of reviews. In these analyses, first I show that NGO activity, after controlling for the amount of state activity, human rights record, region, and issue area, is related to higher rates of states rejecting recommended changes and thus the exhibition of resistance to international pressure. Second, state rejection of recommendations increases with the level of demands in the recommendation, worsening human rights records, and when the recommendation covers specific international obligations or political rights such as basic freedoms and the rule of law. Moreover, recommendations covering women\u27s rights or the rights of the child are more likely to be accepted. Third, I establish that states express their resistance to international human rights norms in one of two fashions: with culturally-, religiously-, or nationally-particularistic claims or with appeals to state sovereignty. Finally, I highlight the centrality of NGOs in the monitoring process between cycles of the UPR process, tying NGO engagement and participation over the duration to reporting on compliance with recommended changes from the preceding cycle of review

DO ACOUSTIC PHONETIC CORRELATES VARY IN RELATION TO GRAMMATICAL FUNCTIONS? EXEMPLIFICATION WITH Her

Do speakers produce the same word differently if its grammatical function changes? The word is used to provide some answers. This word is optimal because it is one of a few English words whose orthography and pronunciation remain the same across three grammatical functions. is spelled and pronounced the same when it functions as a direct object, an indirect object, or a possessive adjective. This makes it ideal for investigating any putative correlation between grammatical functions and acoustic phonetic correlates. Twenty (10 females and 10 males) speakers of American English from 10 different states recorded themselves reading the Speech Accent Archive (SAA) elicitation paragraph in which occurs four times surrounded by 31 different words. We extracted F0/pitch, F1, F2, F3, F4, intensity, and duration correlates from and the surrounding words, for a total of 4,340 measured tokens. For this paper, we focus exclusively on F0/pitch, intensity, and duration to test the existence of a putative correlation. Arithmetic means, standard deviations, and interspeaker variability analyses are provided to answer the research question. The findings help to posit the existence of the proximity and the declination principles, as a way of accounting for why correlations exist in some cases but not in others

Design and Validation of a Soft Switch for a Virtually Variable Displacement Pump

University of Minnesota M.S.M.E. thesis. June 2015. Major: Mechanical Engineering. Advisor: James Van de Ven. 1 computer file (PDF); vii, 109 pages.Switch-mode hydraulic control is a compact and theoretically efficient alternative to throttling valve control or variable displacement pump control. The virtually variable displacement circuit created by a pulse-width modulated high-speed valve has drawbacks, such as large energy losses due to throttling and compressibility during valve transitions. Hydraulic soft switching was proposed as method of reducing the throttling energy loss, by absorbing, in a small variable volume chamber, the flow that would normally be throttled across the transitioning high speed valve. An active locking mechanism was presented by Van de Ven that overcomes the main challenge with soft switching, which is a lock mechanism that releases quickly and with precise timing. A numerical model is developed for a switch-mode pumping circuit, utilizing the proposed soft switch. The model is then used as a means of designing a proof of concept prototype to further verify the model and provide a future optimization tool. The prototype design includes methods for controlling the soft switch spring preload, travel distance, piston displacement required to unlock the soft switch, valve command duty ratio, switching cycle length, and load pressure. Testing demonstrated that the soft switch circuit performed as expected within a set of parameter values, defining normal operation. High control valve switching periods, high load pressures, high flow rates, low soft switch unlocking distances, and low spring preloads caused the soft switch to unlock prematurely in the switching cycle. This resulted in the soft switch to failing to absorb the switched volume pressure spike during control valve transitions, leading to low efficiencies. Under normal operating conditions, the soft switch circuit was calculated to be 60.9% efficient, which is lower than the 62.1% efficiency for same circuit without a soft switch, and also lower than the 70.5% efficiency predicted by the numerical model. The discrepancies between the numerical and experimental model can be attributed to poor resolution in the measurement instruments, as well as the model not accurately capturing flow dynamics through the check valves behind the soft switch piston. Since the soft switch parameters were chosen to validate the lock release concept, and not to maximize efficiency, it was not unexpected that the baseline soft switch case had lower efficiency than the control case. Using the insights gained from these model comparisons, an efficient locking soft switch can be designed for use in a dual soft switch circuit scheme, shown by Van de Ven to reduce energy losses by 66% compared to a control circuit. A successful hydraulic soft switch circuit will allow for the use of slower switching valves, which will reduce component cost as well as energy consumption

Management Approaches for the Control of Aquatic Plants

This guide is designed to provide information on the ecological values and problems associated with aquatic macrophytes, to present methods used to control the troublesome species, and to provide suggestions on how to implement a lake management plan that would deal with macrophytes as legally and as safely as possible

Mining Expertise to Maximize Support: Leveraging Campus Partnerships for Text and Data Mining

Shifts in researchers’ text and data mining (TDM) needs, tools, and methods in the last decade have led to the development of new modes of information access and retrieval. These modes are not always well-aligned with the services traditionally offered by academic libraries and have led to demands for new forms of expertise and institutional support. While some vendors and publishers have built new TDM platforms and access points, it has become clear that academic librarians are unlikely to be able to support the full scope of TDM research from within the confines of traditional models of library support. This chapter considers possibilities for building and maintaining campus partnerships that will ensure expert support across the entire TDM research lifecycle