Increasing Opioid Abuse Screening in Primary Care Clinic: An Evidence-Based Quality Improvement Project

Introduction To address substance abuse multiple organizations recommend increase drug abuse screening as part of routine health care. CAGE AID is five-question tool used to screen for drug and alcohol use, answering yes to two or more questions indicates further assessment is advised. Unfortunately, most primary care centers do not use screen for substance abuse using validated instrument tools such as the CAGE-AID tool. Purpose The purpose of this evidence-based practice (EBP) project is to implement the CAGE-AID Substance abuse screening tool by nurse practitioners students in a family clinic located in Bridgeport in order to increase to number of referrals to primary provider or further evaluation. Intervention/Setting The institute of healthcare improvement (IHI) model for improvement and the EBP model was utilized to guide the implementation of this project in family clinic located in Bridgeport, where screening was not the current practice. The project manager educated two advance licensed practitioners students (ALPS) who were doing their clinical hours at the family clinic (one nurse practitioner student and one physician assistant student). The goals, of the education was to show them how to use the CAGE-AID substance abuse screening tool. The two ALPS were assigned to screen 200 adult patients presenting to clinic for any complaints using the CAGE aid tool before primary care provider (MD/NP/PA) had a face-face encounter. The screeners recorded the number of patients screened per week and the number of patients referred to the primary provider for further assessment. Data was scheduled to be collected over 8 weeks. The Outcomes were measured after the implementation of screening with the number of positive screens referred to the primary care provider for further testing. Results The project manager did not achieve full project implementation due to loss of buy-in from key stakeholders due to the covid 19 pandemic. From the total 200 planned patients to be screened, only 18 were screened over a period of two weeks. Out of the 18 patients, only two patients screened positive for substance abuse. One of the patients had a previous history of substance abuse but another referral was made. The other patient was referred to the primary doctor for further assessment. Other limitations included resistance to change, and inability to return to the clinic to continue implementing the project. Evaluation Full implementation was not achieved, from 18 patients screened, two were referred (11%) for possible substance abuse and brought to the attention of the primary care provider for further assessment. There was no data before implementing the QI project regarding the number of screened patients for substance abuse, so this was a new change in practice. Discussion There was a 11% increased referral for further assessment compared to no recorded data prior implementation. But considering the small sample limitation and incomplete implementation of this project, this writer recommends further studies/testing to corroborate that increasing substance abuse screening can increase patient referrals to primary provider for further evaluation. This project did not lead to a change of practice protocol in regard of substance abuse screening at the family clinic

Estudio de la reactividad de sistemas insaturados frente a zwitteriones tipo koshar. Aplicaciones sintéticas

Koshar’s zwitterions have not been studied since 1976. Fortunately, in 2013 Yanai’s group rediscovered them, improving their synthesis and performing a deep analysis of their properties and characteristics. This work was the starting point of a new research line in our group and hasled to the present PhD Thesis. The in situ formation of the molecule Tf2C=CH2 in solution, from Koshar’s zwitterions, made us consider the study of its behavior and synthetic utility with different unsaturated groups and heterocyclic systems. On the other hand, the development of cyclization methodologies to obtain highly tensioned rings is of great interest. Cyclobutenes, cyclobutenones and cyclobutenols are included in this group. These four-membered carbocycles are molecules with great synthetic utility but difficult to access; and particularly if their formation is required with chemo-, regio- and stereoselectivity..

Alcotán europeo – Falco subbuteo Linnaeus, 1758

Aves - Orden Falconiformes - Familia Falconidae en la Enciclopedia Virtual de Vertebrados Españoles, http://www.vertebradosibericos.org/. Versiones anteriores: 14-06-2005; 16-01-2007; 29-01-2010; 31-03-2014A comprehensive review of the natural history of the Hobby Falco subbuteo in Spain.Peer reviewe

Economical microscale predictions of wind over complex terrain from mesoscale simulations using machine learning

The ability to assess detailed wind patterns in real time is increasingly important for a variety of applications, including wind energy generation, urban comfort and environmental health, and drone maneuvering in complex environments. Machine Learning techniques are helping to develop accurate and reliable models for predicting local wind patterns. In this paper, we present a method for obtaining wind predictions with a higher resolution, similar to those from computational fluid dynamics (CFD), from coarser, and therefore less expensive, mesoscale predictions of wind in real weather conditions. This is achieved using supervised learning techniques. Four supervised learning approaches are tested: linear regression (SGD), support vector machine (SVM), k-nearest neighbors (KNn) and random forest (RFR). Among the four tested approaches, SVM slightly outperforms the others, with a mean absolute error of 1.81 m/s for wind speed and 40.6$$^{\circ }$$ ∘ for wind direction. KNn however achieves the best results in predicting wind direction. Speedup factors of about 290 are achieved by the model with respect to using CFD

Evaluación de la eficacia a largo plazo de los fármacos tiopurínicos en la enfermedad inflamatoria intestinal

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 19-12-2016Esta tesis tiene embargado el acceso al texto completo hasta el 19-06-201

Gender differences in treatment adherence among youth with cystic fibrosis: Development of a new questionnaire

AbstractBackgroundSome prior studies have reported that girls with cystic fibrosis (CF) experience higher morbidity and mortality compared to boys. In this study, the authors compared boys' and girls' perceptions of disease-related strains and resources associated with living with CF, and the relationship of these factors to CF treatment feelings and behaviors.MethodsAll 10–21 year olds with CF at the Minnesota Cystic Fibrosis Center were invited by mail to complete a new self-report survey (Living with CF Questionnaire — LCFQ). Of these 177 youth, 58% (49 boys and 54 girls) returned surveys.ResultsExploratory and confirmatory factor analyses revealed nine factors in the LCFQ. Partial support was found for hypothesized gender differences in these factors. Compared to boys, girls reported significantly more illness-related strains and worries, including emotional strains, greater treatment discouragement, lower self-esteem, and lower adherence to some aspects of the CF treatment regimen (coughing, eating high-fat foods, taking meds/pills).ConclusionsLiving with CF appears to have a greater emotional impact on adolescent girls compared to boys. These gender differences may contribute to the poorer pulmonary function observed among girls with cystic fibrosis during the adolescent years

Resultado clínico a corto plazo de niños con hidronefrosis diagnosticada prenatalmente Instituto Nacional de Salud del Niño San Borja, 2022

El presente proyecto de investigación tiene por objetivo principal comparar los resultados clínicos a corto plazo en los niños con hidronefrosis diagnosticada prenatalmente atendidos en el Instituto Nacional de Salud del Niño San Borja, 2022. Las anomalías congénitas del riñón y del tracto urinario como la hidronefrosis juegan un papel causal en el 30 y 50% de la enfermedad renal en etapa terminal en niños.12 Por tanto, es fundamental diagnosticar estas anomalías de forma temprana para iniciar terapia que minimice el daño renal, prevenir o retrasar la aparición de enfermedad renal y brindar atención de apoyo para evitar complicaciones en el tracto urinario. La detección temprana de estas condiciones puede ser muy efectiva en el diagnóstico y tratamiento oportuno de la enfermedad

Equipo de electrocoagulación con electrodos móviles para el tratamiento de aguas de pozo

Identificación del contexto donde se realizó el estudio: Se observó previamente la situación de la población consumidora de aguas de pozo en los distritos de la provincia de Cañete y Lima Sur, tomando distintas muestras para aplicar el equipo de electrocoagulación con electrodos móviles y comprobar la modificación de sus parámetros. Solución al problema: Esta investigación comprende un desarrollo progresivo de diferentes etapas que inicia desde la recopilación bibliográfica y revisión de los antecedentes hasta el procesamiento de los datos obtenidos en la experimentación mediante la aplicación del equipo en las aguas de pozo recopiladas y sus resultados han generado la eficiencia del equipo producto de la investigación. Procedimientos realizados: Se realizaron nueve ensayos con aguas de tres pozo, cada cinco, diez y quince minutos aplicando diferencias de potencial de tres, seis y nueve voltios a velocidades de cuarenta, noventa, y ciento cuarenta revoluciones por minuto (rpm), los resultados obtenidos se usaron para las pruebas de hipótesis. Los instrumentos de medición empleados son, conductímetro (con lector de conductividad y solidos totales disueltos (STD)), ph metro, cronómetro, y velocímetro digital. Aspectos a resaltar: En esta investigación se diseñó y construyó un Equipo de Electrocoagulación con Electrodos Móviles, distinto a los existentes los que tienen electrodos estáticos con tanque trapezoidal. El equipo de carácter único en este género fue sometido a prueba de funcionamiento electrocoagulando aguas de pozo demostrando su eficiencia. Resultados: Se comprueba la eficiencia del equipo en la modificación de la conductividad, el pH y los sólidos totales disueltos de las aguas de pozo

REPASA, un Repositorio Web de objetos de aprendizaje estandarizados por taxonomías

El repositorio RepASA de material didáctico es una aplicación Web cuyo principal objetivo es el de facilitar a los alumnos y profesores de diferentes materias, compartir y acceder a material educativo que les ayude en sus estudios. A diferencia de otros recursos similares, este repositorio tiene la ventaja de que son sus propios usuarios registrados quienes, mediante sus propias subidas de material, se encargan de actualizar y de controlar sus contenidos, incluso los de otros usuarios. Nuestro objetivo principal ha sido crear una aplicación útil para todo tipo de estudiantes y profesores a la hora de compartir material didáctico de diferentes campos, además de que sea fácil de buscar y encontrar lo que se necesite, incluso donde gente no registrada también puede aprovechar lo que se publica en el repositorio. [ABSTRACT] The RepASA repository of teaching materials is a web application whose main purpose is to provide students and teachers of different subjects, share and access to educational materials to help them in their studies. Unlike other similar resources, this repository has the advantage that they are their own registered users who, through their own material upload, are responsible for updating and controlling its content, including by other users. Our main goal has been to create a useful application for all students and teachers in sharing teaching materials in different fields, as well as make it easy to search and find what you need, even no registered people can also benefit of what published in the repository