Tools To Increase Compliance and Decrease Mortality Due To Sepsis

Severe sepsis is a leading cause of death in the United States and is the most common cause of death among critically ill patients in non-coronary intensive care units (Mayr, Yende, & Angus, 2014). The incidence of severe sepsis is estimated to be 300 cases per 100,000 population and cost an estimated $14 billion in the United States (Mayr et al., 2014). This Doctor of Nursing Practice (DNP) project focused on identifying an early-assessment tool to identify sepsis and increase compliance when using the tool. Identifying sepsis early is important in starting a treatment plan to prevent morbidity and mortality. For this project, a SWOT analysis was developed for the Modified Early Warning Score (MEWS) and the Quick Sequential Organ Failure System (QSOFA). This SWOT analysis and the research that was found was presented to staff in the Post-Anesthesia Care Unit (PACU) and Operating Room (OR). A pamphlet and in-service providing a description of QSOFA and MEWS were given to the nurses and also anesthesia providers. This in-service was presented during the monthly meeting that the staff conducts. A five-question survey was given after the in-service to the participants. This survey asked about the opinions and concerns of each tool. The participants had one week to complete the survey. The completed surveys were placed in a box located in the PACU and collected after one week. The data was then compiled and analyzed. The sample size included six PACU nurses and six Certified Registered Nurse Anesthetists (CRNA). An overwhelming response was found in favor of the MEWS tool. The vast majority of staff stated that MEWS was more user-friendly, would increase compliance due to sepsis, and would be most likely to decrease morbidity and mortality due to sepsis when compared with the other tool

A Semi-Analytical Line Transfer (SALT) Model III: Galactic Inflows

We present calculations of ultraviolet spectra resulting from the scattering of photons by gas in-falling onto an isotropically emitting source of radiation. The model is based on an adaptation of the semi-analytical line transfer (SALT) code of Scarlata & Panagia (2015), and designed to interpret the inverse P-Cygni profiles observed in the spectra of partially ionized galactic inflows. In addition to presenting the model, we explore the parameter space of the inflowing SALT model and recreate various physically motivated scenarios including spherical inflows, inflows with covering fractions less than unity, and galactic fountains (i.e., galactic systems with both an inflowing and outflowing component). The resulting spectra from inflowing gas show spectral features that could be misinterpreted as ISM features in low resolution spectroscopy ($\sigma \approx 120$ $\rm{km }$ $\rm{s}^{-1}$), suggesting that the total number of galactic systems with inflows is undercounted. Our models suggest that observations at medium resolution ($R = 6000$ or $\sigma \approx 50$ $\rm{km }$ $\rm{s}^{-1}$) that can be obtained with 8m-class telescopes will be able to resolve the characteristic inverse P Cygni profiles necessary to identify inflows.Comment: Accepted by Ap

A Semi-Analytical Line Transfer (SALT) Model For Bi-conical Galactic Outflows

University of Minnesota M.S. thesis. August 2017. Major: Astrophysics. Advisor: Claudia Scarlata. 1 computer file (PDF); vii, 40 pages.We generalize the semi-analytical line transfer (SALT) model recently introduced by Scarlata and Panagia (2015) for modeling galactic outflows, to account for bi-conical geometries of various opening angles and orientations with respect to the line-of- sight to the observer, as well as generalized velocity fields. We model the absorption and emission component of the line profile resulting from resonant absorption in the bi-conical outflow. We show how the outflow geometry impacts the resulting line profile. We use simulated spectra with different geometries and velocity fields to study how well the outflow parameters can be recovered. We find that geometrical parameters (including the opening angle and the orientation) are always well recov- ered. The density and velocity field parameters are reliably recovered when both an absorption and an emission component are visible in the spectra. This condition implies that the velocity and density fields for narrow cones oriented perpendicular to the line of sight will remain unconstrained. To conclude, we fit the model to 10 highly compact galaxies (commonly referred to as Green Peas). We observe strong evidence for bi-conical geometries

Testing SALT Approximations with Numerical Radiation Transfer Code Part 1: Validity and Applicability

Absorption line spectroscopy offers one of the best opportunities to constrain the properties of galactic outflows and the environment of the circumgalactic medium. Extracting physical information from line profiles is difficult, however, for the physics governing the underlying radiation transfer is complicated and depends on many different parameters. Idealized analytical models are necessary to constrain the large parameter spaces efficiently, but are typically plagued by model degeneracy and systematic errors. Comparison tests with idealized numerical radiation transfer codes offer an excellent opportunity to confront both of these issues. In this paper, we present a detailed comparison between SALT, an analytical radiation transfer model for predicting UV spectra of galactic outflows, with the numerical radiation transfer software, RASCAS. Our analysis has lead to upgrades to both models including an improved derivation of SALT and a customizable adaptive mesh refinement routine for RASCAS. We explore how well SALT, when paired with a Monte Carlo fitting procedure, can recover flow parameters from non-turbulent and turbulent flows. When the velocity and density gradients are excluded, we find that flow parameters are well recovered from high resolution (20 $\rm{km}$ $\rm{s}^{-1}$) data and moderately well from medium resolution (100 $\rm{km}$ $\rm{s}^{-1}$) data without turbulence at a S/N = 10, while derived quantities (e.g., mass outflow rates, column density, etc.) are well recovered at all resolutions. In the turbulent case, biased errors emerge in the recovery of individual parameters, but derived quantities are still well recovered

Concert recording 2018-02-09

[Track 1]. Marche á huit instrumens á vent / Nannette Streicher -- [Track 2]. Dixtuor pour instruments á vent. I. Allegro moderato II. Moderato [Track 3]. III. Andante - Allegro scherzando [Track 4]. IV. Cantabile [Track 5]. V. Allegro risoluto / Claude Arrieu, née Louise Marie Simon -- [Track 6]. Octet for windinstruments / Tera de Marez Oyens -- [Track 7]. The unfortunate traveller, suite for brass band. I. Introduction II. Scherzo [Track 8]. III. Interlude [Track 9]. IV. March / Imogen Holst

CLASSY VII Ly\alpha\ Profiles: The Structure and Kinematics of Neutral Gas and Implications for LyC Escape in Reionization-Era Analogs

Lyman-alpha line profiles are a powerful probe of ISM structure, outflow speed, and Lyman continuum escape fraction. In this paper, we present the Ly$\alpha$ line profiles of the COS Legacy Archive Spectroscopic SurveY, a sample rich in spectroscopic analogs of reionization-era galaxies. A large fraction of the spectra show a complex profile, consisting of a double-peaked Ly$\alpha$ emission profile in the bottom of a damped, Ly$\alpha$ absorption trough. Such profiles reveal an inhomogeneous interstellar medium (ISM). We successfully fit the damped Ly$\alpha$ absorption (DLA) and the Ly$\alpha$ emission profiles separately, but with complementary covering factors, a surprising result because this approach requires no Ly$\alpha$ exchange between high-$N_\mathrm{HI}$ and low-$N_\mathrm{HI}$ paths. The combined distribution of column densities is qualitatively similar to the bimodal distributions observed in numerical simulations. We find an inverse relation between Ly$\alpha$ peak separation and the [O III]/[O II] flux ratio, confirming that the covering fraction of Lyman-continuum-thin sightlines increases as the Ly$\alpha$ peak separation decreases. We combine measurements of Ly$\alpha$ peak separation and Ly$\alpha$ red peak asymmetry in a diagnostic diagram which identifies six Lyman continuum leakers in the CLASSY sample. We find a strong correlation between the Ly$\alpha$ trough velocity and the outflow velocity measured from interstellar absorption lines. We argue that greater vignetting of the blueshifted Ly$\alpha$ peak, relative to the redshifted peak, is the source of the well-known discrepancy between shell-model parameters and directly measured outflow properties. The CLASSY sample illustrates how scattering of Ly$\alpha$ photons outside the spectroscopic aperture reshapes Ly$\alpha$ profiles as the distances to these compact starbursts span a large range.Comment: 40 pages, 19 figures, 5 tables, submitted to ApJ, comments welcom

Why health visiting? Examining the potential public health benefits from health visiting practice within a universal service: A narrative review of the literature

INTRODUCTION: There is increasing international interest in universal, health promoting services for pregnancy and the first three years of life and the concept of proportionate universalism. Drawing on a narrative review of literature, this paper explores mechanisms by which such services might contribute to health improvement and reducing health inequalities. OBJECTIVES: Through a narrative review of empirical literature, to identify: DESIGN: The paper draws upon a scoping study and narrative review. REVIEW METHODS: We used three complementary approaches to search the widely dispersed literature: Our key inclusion criterion was information about health visiting practice. We included empirical papers from United Kingdom (UK) from 2004 to February 2012 and older seminal papers identified in search (3), identifying a total of 348 papers for inclusion. A thematic content analysis compared the older (up to 2003) with more recent research (2004 onwards). RESULTS: The analysis revealed health visiting practice as potentially characterized by a particular 'orientation to practice.' This embodied the values, skills and attitudes needed to deliver universal health visiting services through salutogenesis (health creation), person-centredness (human valuing) and viewing the person in situation (human ecology). Research about health visiting actions focuses on home visiting, needs assessment and parent-health visitor relationships. The detailed description of health visitors' skills, attitudes, values, and their application in practice, provides an explanation of how universal provision can potentially help to promote health and shift the social gradient of health inequalities. CONCLUSIONS: Identification of needs across an undifferentiated, universal caseload, combined with an outreach style that enhances uptake of needed services and appropriate health or parenting information, creates opportunities for parents who may otherwise have remained unaware of, or unwilling to engage with such provision. There is a lack of evaluative research about health visiting practice, service organization or universal health visiting as potential mechanisms for promoting health and reducing health inequalities. This paper offers a potential foundation for such research in future

Revisiting the Historic Distribution and Habitats of the Whooping Crane

Understanding the historic range and habitats of an endangered species can assist in conservation and reintroduction efforts for that species. Individuals reintroduced into a species’ historic core range have a higher survival rate compared to individuals introduced near the periphery or outside the historic range (Falk and Olwell, 1992; Griffith et al., 1989). Individuals on the periphery of a species’ range tend to occupy less favorable habitats and have lower and more variable densities than those near the core of their range (Brown, 1984; Brown et al., 1995, 1996). Such conclusions, however, presume that historic habitats have not changed since a species was extirpated from core areas – a difficult assumption for many areas, and particularly for wetland habitat (Prince, 1997). Many endangered species persist only on the periphery of their historic range because of habitat loss or modification in their core range (Channell and Lomolino, 2000), which can bias our understanding of the species’ habitat preferences. Further, habitat models based on locations where species persist necessarily emphasize local conditions rather than historical conditions (Kuemmerle et al., 2011). For example, habitat models for the European bison (Bison bonasus) suggested it was a woodland species, but assessment of the bison’s historic range indicated it preferred mosaictype landscapes and had a more eastern and northern distribution than previously reported (Kuemmerle et al., 2011, 2012). Hence, accurate determination of the historic range and habitat conditions for endangered species can improve our understanding of their ecology and assist in conservation and reintroduction efforts. Examining the historic range from an ecological perspective can also help identify where appropriate habitat still exists that could sustain a population