Environmental noise as risk factor for postoperative delirium in an orthopedic sample: an exploratory, correlational study

Postoperative delirium (PD) affects approximately 25 percent of participants over the age of 60 having major surgery. Long term negative effects include persistent delirium, loss of independence, nursing home placement, and mortality. There is evidence that incidence is related in-part to multifactorial precipitating and predisposing factors; however, none of the studies found evaluated perioperative environmental factors. One environmental factor that may influence the severity of PD is intraoperative noise. A surgical population with an increased incidence of delirium is orthopedic surgery. Orthopedic surgery, such as total hip or knee arthroplasties, involves the use of equipment such as loud drills and saws. The incidence of PD in those having orthopedic procedures is between 41% and 50%. The purposes of this study were to describe the environmental noise in an orthopedic operating room environment during arthroplastic surgery and to explore the relationship operational noise variables to the incidence and severity of PD. The correlational design is a non-experimental method chosen to examine the strength of the relationship between perioperative noise in the orthopedic total knee or hip arthroplasty suite and the incidence of PD. A convenience sample was comprised of participants presenting at their pre-anesthesia assessment visit and ending when the calculated sample size has been reached. This exploratory study demonstrated inconsistent findings in relation to noise loudness and pitch variables and delirium severity. However, all noise levels exceeded US governmental agencies recommended maximum levels and may put patients and personnel at risk. More research is needed to further investigate hospital noise and outcomes

Studies on bacterial Efflux pump inhibitors in land plants

The research presented in this dissertation deals with the phenomena of bacterial efflux pump inhibition by natural products and plant extracts. Bacterial efflux pumps are active transport proteins, primarily deriving their energy source from the proton motive force, which functions to export toxic compounds outside the cell. This is a natural defense mechanism that bacteria utilize to protect themselves from toxic environments. The over-production of efflux pumps is one mechanism by which bacteria can evolve resistance to clinical antibiotics, as well as other antimicrobials. Thus, the study of efflux pump inhibitors is important because it holds the potential to reverse some forms of antibiotic resistance. In light of this importance, a series of studies were designed to improve the ability to study this phenomenon, to investigate the distribution of efflux pump inhibition in land plants, and to improve our ability to identify an important class of efflux pump inhibitors, the flavonoids. The first aim of this research was to develop an improved method for experimentally quantifying efflux pump inhibitory activity of small molecules. Preexisting methods made this difficult due to several limitations including: the collection of indirect results, time consuming materials handling techniques, and/or matrix interference problems pertaining to the quenching of fluorescent signal. An improved method relying on mass spectrometry measurements was developed that addressed the aforementioned limitations. The importance of this improved method lies in its ability to produce data sets useful in calculating IC50 values for a wider range of samples than was previously possible. The second aim was to evaluate the presence of efflux pump inhibitor production across the land plant lineage. This is important to botanical science and the understanding of plant-microbe interactions and plant evolutionary biology. The most ancient lineages of land plants have not been previously evaluated for efflux inhibitory activity. Additionally, land plants play an important role in many traditional medicinal systems and in modern complementary and alternative medicine. Thus, understanding the distribution of efflux pump inhibitor production in this group increases our understanding of these common forms of medical treatment. In order to gain these data, a set of 14 plant species spanning the major lineages within the land plant group (bryophytes, pterophytes and lycophytes, gymnosperms, and angiosperms) were extracted and assayed to determine efflux pump inhibitory activity of the extracts. Positive results (indicating the presence of an efflux pump inhibitor) were observed for many (but not all) of the plant species tested. The observation of activity in extracts prepared from the most ancient plants tested (bryophytes--the liverworts and mosses) lends credence to the hypothesis that the production of efflux pump inhibitors is of great antiquity in land plants. The last component of this work was the evaluation of methods for the analysis of flavonoids via mass spectrometry. This is of importance to this study due to the commonality of flavonoids in the literature pertaining to efflux pump inhibitors, and the consistency activity of the flavonoids evaluated in Chapter II. The goal of this work was to compare two methods for the tentative identification of signals in complex data produced via high-resolution mass spectrometry that could be labeled as "possible flavonoids." The methods evaluated were firstly the use of mass spectrometry fragmentation spectra to identify key diagnostic fragments of the flavonoid ring structure and secondly the use of mass defect filtering directly applied to high resolution data to select a short list of signals for further processing. The former method was not fruitful due to a combination of the frequent poor fragmentation and the dependency on standards for all samples. The latter proved more useful, successfully producing a list of potential flavonoids to be carried forward to other methods such as database searching and molecular formula calculation. This method was also successfully applied to a complex extract of Hydrastis canadensis, identifying three flavonoids known from previous work to be present. Further, the mass defect method is an intrinsic property of molecules, and therefore does not change with experimental conditions. For all of these reasons mass defect was selected as the more useful of the two methods evaluated for the identification of "possible flavonoid" signals in crude extracts

Encouraging Arithmetic: A Classroom Experiment

Mathematics is a major part of today’s society and is used in nearly everyone’s day to day life. Despite the importance of mathematics many students avoid this subject and only do the bare minimum to pass classes. Recent studies have concluded that the environment of the classroom and the attitude of the teacher can affect students’ attitude and successfulness in mathematics. In an attempt to find activities that would change the classroom environment in a positive way I developed a three-day program that I implemented with a classroom of middle grade students. In the following paper I have recorded the experience and my thoughts on the program

Elements contributing to the rate of adoption of the Healthy youth act in North Carolina schools

Teenage pregnancy is a major public health concern facing the United States. To address this, North Carolina passed the Healthy Youth Act, mandating all school districts adopt at minimum abstinence plus reproductive health and safety curriculum. The goal of the study was to apply the Diffusion of Innovations (DOI) framework to explain the rate of adoption of the Healthy Youth Act by the school districts. Using a mixed methods approach, a quantitative survey and follow-up interviews were conducted with curriculum coordinators statewide to investigate how the perceived attributes of an innovation contribute to adoption. The survey results indicated that relative advantage and compatibility are significantly associated with policy adoption. This was further supported by the interviews, with participants discussing how the new policy allowed them to better educate and meet the needs of the student population. Finally, perceptions of the community influenced the process undertaken to adopt the policy, leading to greater transparency than necessary. Discussion and conclusion include outreach to policy makers and those in charge of administration and continued/expanded inclusion of the community in policy efforts

Metabolic Impact of Sex Hormones on Obesity

Obesity and its associated health disorders and costs are increasing. Men and postmenopausal women have greater risk of developing complications of obesity than younger women. Within the brain, the hypothalamus is an important regulator of energy homeostasis. Two of its sub-areas, the ventrolateral portion of the ventral medial nucleus (VL VMN) and the arcuate (ARC) respond to hormones and other signals to control energy intake and expenditure. When large lesions are made in the hypothalamus which includes both the VL VMN and the ARC, animals eat more, have reduced energy expenditure, and become obese. The ARC and the VL VMN, in addition to other regions in the hypothalamus, have been demonstrated to contain estrogen receptors. There are two estrogen receptors, estrogen receptor alpha (ERa) and estrogen receptor beta (ERß). We and others have previously demonstrated that activation of ERa by estrogens reduces food intake and increases body weight. This review focuses on the relative contribution of activation of ERa by estrogens in the ARC and the VL VMN in the regulation of food intake and body weight. Additionally, estrogen receptors have been found in many peripheral tissues including adipose tissue. Estrogens are thought to have direct effects on adipose tissue and estrogens may provide anti-inflammatory properties both in the periphery and the in the central nervous system (CNS) which may protect women from diseases associated with inflammation. Understanding the mechanisms by which estrogens regulate body weight and inflammation will assist in determining potential therapeutic agents for menopausal women to decrease the propensity of diseases associated with obesity

The current context of education and the middle school concept: what works in middle schools?

The goal of this project was to gain insight from public school middle school principals regarding what works in middle grades education and how accountability affected the organization of middle schools. Three research questions were considered in this exploratory study: 1. What is the status of the middle school model in the early 21st century? 2. According to middle school principals, how has No Child Left Behind and accountability affected their implementation of the middle school model? 3. How do middle school principals deal with the tensions between No Child Left Behind and the middle school model? In order to gain this insight, literature about middle schools was studied, two middle schools were visited, and human participants provided feedback through a survey. As a follow up to the survey, nine survey participants consented to a more in depth follow-up interview. Through this research it was determined that accountability standards are looked upon favorably by many administrators, however, the standards have forced some schools to restructure their days in ways that do not mirror the original middle school concept that still provides a framework for middle school education. Of the principals surveyed and interviewed there was still a strong desire to educate the whole child, to allow students opportunities to explore, and to develop relationships with students as the middle school model suggested. Based on the research the reader can surmise that the middle school concept can and should still be used in middle schools

Establishing A Parish Nursing Program.

Parish nurses are health educators who integrate faith and health to keep the body, mind, and soul healthy and happy. In the US, there are over 3,000 parish nurses who are considered educators, personal health counselors, and trainers of volunteers. Their fundamental belief in the relationship between health and spirituality separates them for other types of nurses

Fun and Games in reviewing neonatal emergency care

Objective: To develop a game-based review instrument for use by newborn caregivers in preparing for emergency situations. Design: One hundred and one test questions covering pathophysiology, resuscitation, and medications were developed. The questions then underwent expert and peer review, psychometric testing for content validity and test-retest reliability, and a game trial. Analysis: The needs of adult learners are different from those of other learners. The gaming format uses knowledge gained through experience and provides an avenue for validating knowledge and sharing experiences. This format has been found effective for review and reinforcement of facts. Twelve nurses participated in a trial game and completed a written eval-uation using a Likert scale. Conclusion: The Neonatal Emergency Trivia Game is an effective tool for reviewing material related to neonatal emergency care decisions. Additional testing with a larger group would strengthen validity and reliability data

Predicting children's emotion regulation behaviors from maternal emotion socialization and vagal suppression

The relation between early maternal emotion socialization and children's emotion regulation behaviors were examined across a short-term longitudinal study. Participants were 196 children with data collected at age 3.5 and 4.5-years-old. It was hypothesized that children's vagal suppression at age 4.5 would partially mediate the association between maternal emotion socialization and children's emotion regulation behaviors. To assess maternal emotion socialization, mothers completed the Coping with Children's Negative Emotions (CCNES) questionnaire and a supportive and non-supportive aggregate were created. To assess children's emotion regulation behaviors mothers completed the Emotion Regulation Checklist (ERC) and trained research assistants coded a laboratory frustration task for observed emotion regulation behaviors. Results indicate that emotion socialization did not predict vagal suppression or emotion regulation behaviors. Further, vagal suppression was not associated with emotion regulation behaviors. Thus, a mediation effect was not present. Results are discussed in terms of directions for future research

Preventing Secondary Pregnancy in Adolescents: A Model Program.

The Dollar-A-Day program in Greensboro, North Carolina, was established in 1990 to prevent subsequent pregnancies in girls under 16 years of age who had already given birth to one child. Conceptualized by nursing professors and using principles from theories of adolescent development and social exchange, the program was planned and implemented in collaboration with nurses from the local health department. Weekly meetings featured food, an informal program focused on needs identified by members, setting of short-term goals, and an award of a dollar for each day they remained nonpregnant. After five years of operation with a series of small grants, only 15% of the 65 girls who had been enrolled in the program experienced subsequent pregnancies. The success of the program convinced health department officials to incorporate Dollar-A-Day into their budget as a permanent service to the population of adolescents they serve. It remains as a model program for others to emulate