Current Management of Acute Hyperglycemia: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome

The purpose of this poster is to review and promulgate current best practices in management of the two forms of hyperglycemic crises: diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS). Reviews of literature showed large agreement on efficacious protocols in acute hyperglycemic treatment, while also noting wide prevalence of the disorder. Given the high human and financial cost of hyperglycemia, the dissemination of high quality, evidence-based interventions, to the widest possible audience participating in patient care, is imperative. This poster outlines signs and symptoms, basic pathophysiology, and implications for the treatment team with emphasis placed on areas of settled best practices

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is a complex disease discussed in the following poster. ARDS is an inflammatory disease with a high mortality rate, making it a topic of high interest. Numerous different diseases can initiate ARDS, but not everyone who develops one of those diseases goes into ARDS. The inflammatory response within the lungs causes refractory hypoxemia and shunting. Treatments available for ARDS is mechanical ventilation with smaller tidal volumes, prone positioning, and neuromuscular blocking agents. Nurses caring for these critically ill patients must have an understanding of the overall picture of ARDS, while continuously assessing for possible complications and changes. The pathophysiology, signs and symptoms, treatment options, and implications for nursing care are all topics discussed

Implementation and Evaluation of a Structured Mentorship Program

The project addresses mentorship in a graduate nursing anesthesia program. The goal is to improve the existing mentorship program and to implement a durable and consistent system that gathers and responds to feedback from the students. Two literature reviews form the underpinnings of the structure and evaluation components of the project. Three structural components were identified in the review as highly effective in multiple studies of diverse mentorship programs. The first component is establishing an effective dyad matching scheme. The second component is establishing clear goals. The third component is maintaining the relationship and achieving goals through frequent and consistent meetings. In evaluation, an effective tool to assess the program was identified, with small modifications to allow for both quantitative and qualitative responses. A Plan, Do, Study, Act model forms the core of the implementation process. Finally, baseline and ongoing data collection will be used to further guide continuing improvement of the mentorship program

Development Of Real-Time Drinking Water Distribution Systems (DWDS) Modeling Technology Using The EPANET Extended Period Simulation (EPS) Modeling Toolkit

Real-time hydraulic and water quality modeling involves the modification of the EPS network model every few minutes to reflect the SCADA data, and this paper shares how this type of real-time modeling framework, HydroTrek, was built on top of the EPS foundation provided by the EPANET toolkit. The real-life applications of HydroTrek posed some interesting modeling challenges when the hydraulic time-step was reduced to match the SCADA time-step of one to five minutes. For example, a physical pump usually does not instantaneously, but a model pump does. In a sensitive network, that can mean a significant mismatch between the SCADA and model tank demands, and consequently in the modeled tank levels. If the real-time model is updated by discarding ‘all model rules’ and strictly run on the basis of the SCADA component status values, then the tank level discrepancies can get further exacerbated through the opening or closing of valves that influence these tanks . Some systems also operate multiple valves in parallel in a lead-lag configuration and switch the active configuration in a manner that can’t be represented in an EPS model. Increasing the hydraulic time-step can reduce the ‘hydraulic’ problems but has the unfortunate consequence of masking the water quality spikes which are important for anomaly detection and for reduction of false positives in contaminant warning systems. Also, an EPS model may represent a battery of pumps with a single pump curve and may include simple tank mixing, and those may not be sufficient for real-time modeling. The authors conclude that although the EPS toolkit behaves well through the major portion of the real-time simulation, further hydraulic and water quality modeling advances and refinements are needed to improve the match with SCADA data

The gender specific frequency of risk factor and CHD diagnoses prior to incident MI: A community study

BACKGROUND: CHD is a chronic disease often present years prior to incident AMI. Earlier recognition of CHD may be associated with higher levels of recognition and treatment of CHD risk factors that may delay incident AMI. To assess timing of CHD and CHD risk factor diagnoses prior to incident AMI. METHODS: This is a 10-year population based medical record review study that included all medical care providers in Olmsted County, Minnesota for all women and a sample of men residing in Olmsted County, MN with confirmed incident AMI between 1995 and 2000. RESULTS: All medical care for the 10 years prior to incident AMI was reviewed for 150 women and 148 men (38% sample) in Olmsted County, MN. On average, women were older than men at the time of incident AMI (74.7 versus 65.9 years, p < 0.0001). 30.4% of the men and 52.0% of the women received diagnoses of CHD prior to incident AMI (p = 0.0002). Unrecognized and untreated CHD risk factors were present in both men (45% of men 5 years prior to AMI) and women (22% of women 5 years prior to first AMI), more common in men and those without a diagnosis of CHD prior to incident AMI (p < 0.0001). CONCLUSION: A CHD diagnosis prior to incident AMI is associated with higher rates of recognition and treatment of CHD risk factors suggesting that diagnosing CHD prior to AMI enhances opportunities to lower the risk of future CHD events

Humboldt Community Action Plan

Mosaic is working to develop an action plan that will enable the community to better address their concerns. The Humboldt neighborhood is one of the most diverse and rapidly changing areas in the Portland area, constantly challenging the neighborhood association\u27s efforts to reach a diverse, representative population of residents. Through concerted outreach, interviews, and workshops Mosaic Planning has identified a series of goals the neighborhood hopes to one day realize. By thoroughly researching methods to achieve these goals, the group will provide a series of action items to the community, which can be implemented by residents. This plan will help them address neighborhood issues, identify city and local resources, and provide ways to build a stronger community within Humboldt. This project was conducted under the supervision of Sy Adler and Ethan Seltzer