UCANP: Urinary Catheter Alleviation Navigation Protocol Quality Improvement Project

Introduction: Catheter associated urinary tract infections (CAUTI) can place significant financial burden on healthcare facilities, decrease quality of care and increase length of stay. Reducing indwelling urinary catheter days reduces the risk of a CAUTI. Current practice after catheter removal includes the reinsertion of the catheter if the patient demonstrates three episodes of urinary retention that requires intermittent urinary catheterization. Intermittent urinary catheterization, when implemented appropriately, has proven to be safe and decreases risk for urinary infection. Background: Several initiatives have been introduced to decrease hospital CAUTI rates, including nursing education on appropriate urine culture collection, use of root cause analysis (RCA) tools to identify problem areas, and nurse driven removal protocols when catheters are no longer indicated. Despite some decreased catheter utilization rates, CAUTIs continued to occur. Data obtained through RCAs revealed a trend of catheter re-insertions due to urinary retention. A nurse driven pathway was developed using bladder scan and straight catheterization protocols with emphasis on not re-inserting catheters. Study Aim: By utilizing an algorithm for monitoring patients after catheter References removal, which includes routine bladder scan assessment and intermittent urinary catheterization if applicable, this study aimed to reduce the incidence of reinsertion of an indwelling catheter. Decreased re-insertion rates contribute to decreased urinary catheter utilization days and decreased risk for CAUTIs. Results: Metrics utilized to determine improvement included indwelling catheter utilization days and CAUTI count. Catheter days is defined as the number of days an indwelling catheter is in place. Each unit was compared to the previous year for the months of September, October, and November. The combined decrease of catheter days for all units was 17%, 23%, and 34% for September, October, and November, respectively. Discussion: Reducing the use of urinary catheters can reduce rates of catheter-associated urinary tract infections and their associated morbidities. Development of one standard protocol, in collaboration with urology provider input, and applying it across a variety of patient populations led to increased utilization of the protocol by the nursing staff. Improvement was also seen in nurses’ awareness and understanding of urinary retention post catheter removal and using bladder scanning and intermittent catheterization appropriately when needed. Due to the initial success of this project, the UCANP initiative is currently being implemented on additional units and will continue until all patient-care areas of the hospital are included.https://scholarlycommons.henryford.com/nursresconf2021/1006/thumbnail.jp

Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis and treatment

Background: The prevalence and correlates of alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses in Iraq and Afghanistan veterans who are new users of Department of Veterans Affairs (VA) healthcare nationwide has not been evaluated. Methods: VA administrative data were used in retrospective cross-sectional descriptive and multivariable analyses to determine the prevalence and independent correlates of AUD and DUD in 456,502 Iraq and Afghanistan veterans who were first-time users of VA healthcare between October 15, 2001 and September 30, 2009 and followed through January 1, 2010. Results: Over 11% received substance use disorder diagnoses: AUD, DUD or both; 10% received AUD diagnoses, 5% received DUD diagnoses and 3% received both. Male sex, age \u3c 25 years, being never married or divorced, and proxies for greater combat exposure were independently associated with AUD and DUD diagnoses. Of those with AUD, DUD or both diagnoses, 55–75% also received PTSD or depression diagnoses. AUD, DUD or both diagnoses were 3–4.5 times more likely in veterans with PTSD and depression (p \u3c 0.001). Conclusions: Post-deployment AUD and DUD diagnoses were more prevalent in subgroups of Iraq and Afghanistan veterans and were highly comorbid with PTSD and depression. Stigma and lack of universal screening may have reduced the number of DUD diagnoses reported. There is a need for improved screening and diagnosis of substance use disorders and increased availability of integrated treatments that simultaneously address AUD and DUD in the context of PTSD and other deployment-related mental health disorders

Precise Re–Os ages of organic-rich mudrocks and the Os isotope composition of Jurassic seawater

Rhenium and osmium isotope and abundance data have been obtained on precisely-located samples from three suites of immature, organic-rich mudrocks from Jurassic coastal outcrops in England, The data provide accurate whole-rode ages of 207 +/- 12 Ma, 181 +/- 13 Ma and 155 +/- 4.3 Ma for suites of Hettangian, Toarcian (exaratum Subzone) and Kimmeridgian (sensu anglico, wheatleyensis Subzone) samples. These new Re-Os ages are indistinguishable, within the assigned analytical uncertainties, from interpolated depositional ages estimated from published geological timescales, and establish the importance of the Re-Os dating technique for chronostratigraphic studies. Early-diagenetic pyrite nodules possess levels of Re and Os which are similar to 1-2 orders of magnitude lower than in the enclosing organic-rich mudrocks, indicating that these elements had already been removed from sediment pore waters at the time of nodule formation. Thus the Re-Os isotope system in these organic-rich mudrocks has been closed since, or from very soon after, the time of sediment deposition. Because most of the Re (98+%) and Os (95-99.8+%) in the mudrocks is shown to be hydrogenous, the Os-187/Os-188((i)) of the samples is interpreted to be that of contemporaneous seawater. The data thereby provide the first estimates of the Os isotope composition of Jurassic seawater. During the earliest Jurassic (Hettangian), the seawater Os-187/Os-188 ratio was extremely unradiogenic (similar to 0.15); it had increased to similar to 0.8 at the end of the Early Jurassic (Toarcian) similar to 20 Ma later, while in the Late Jurassic (Kimmeridgian) the seawater Os-187/Os-188 ratio was similar to 0.59. The most likely explanation for the unradiogenic Os isotope composition of Hettangian seawater is that the contribution of unradiogenic Os to the oceans from the hydrothermal alteration of oceanic crust greatly exceeded the input of radiogenic Os from the continents at that time. This interpretation is in Line with observations suggesting that global weathering rates were low in the Hettangian, and that increased hydrothermal and volcanic activity preceded the break-up of Pangea. The Re/Os ratios of Hettangian mudrocks (and by inference, of contemporaneous seawater) are similar to those of mudrocks deposited at later times during the Jurassic, and argues against the unradiogenic Os in Hettangian seawater being derived from extraterrestrial meteoritic sources

Evidence for weathering and volcanism during the PETM from Arctic Ocean and Peri-Tethys osmium isotope records

Sudden global warming during the Paleocene–Eocene Thermal Maximum (PETM, 55.9 Ma) occurred because of the rapid release of several thousand gigatonnes of isotopically light carbon into the oceans and atmosphere; however, the cause of this release is not well understood. Some studies have linked carbon injection to volcanic activity associated with the North Atlantic Igneous Province (NAIP), while others have emphasised carbon cycle feedbacks associated with orbital forcing. This study presents the osmium isotope compositions of mudrocks that were deposited during the PETM at four locations (one from the Arctic Ocean, and three from the Peri-Tethys). The Os-isotope records all exhibit a shift of similar magnitude towards relatively radiogenic values across the PETM. This observation confirms that there was a transient, global increase in the flux of radiogenic Os from the weathering of continental rocks in response to elevated temperatures at that time. The tectonic effects of NAIP volcanic emplacement near the onset of the PETM is recorded by anomalously radiogenic Os-isotope compositions of PETM-age Arctic Ocean samples, which indicate an interval of hydrographic restriction that can be linked tectonic uplift due to hotspot volcanism in the North Atlantic seaway. The Peri-Tethys data also document a transient, higher flux of unradiogenic osmium into the ocean near the beginning of the PETM, most likely from the weathering of young mafic rocks associated with the NAIP. These observations support the hypothesis that volcanism played a major role in triggering the cascade of environmental changes during the PETM, and highlight the influence of paleogeography on the Os isotope characteristics of marine water masses

Impacts of Co-Solvent Flushing on Microbial Populations Capable of Degrading Trichloroethylene

With increased application of co-solvent flushing technologies for removal of nonaqueous phase liquids from groundwater aquifers, concern over the effects of the solvent on native microorganisms and their ability to degrade residual contaminant has also arisen. This study assessed the impact of ethanol flushing on the numbers and activity potentials of trichloroethylene (TCE)-degrading microbial populations present in aquifer soils taken immediately after and 2 years after ethanol flushing of a former dry cleaners site. Polymerase chain reaction analysis revealed soluble methane monooxygenase genes in methanotrophic enrichments, and 16S rRNA analysis identified Methylocystis parvus with 98% similarity, further indicating the presence of a type II methanotroph. Dissimilatory sulfite reductase genes in sulfate-reducing enrichments prepared were also observed. Ethanol flushing was simulated in columns packed with uncontaminated soils from the dry cleaners site that were dosed with TCE at concentrations observed in the field; after flushing, the columns were subjected to a continuous flow of 500 pore volumes of groundwater per week. Total acridine orange direct cell counts of the flushed and nonflushed soils decreased over the 15-week testing period, but after 5 weeks, the flushed soils maintained higher cell counts than the nonflushed soils. Inhibition of methanogenesis by sulfate reduction was observed in all column soils, as was increasing removal of total methane by soils incubated under methanotrophic conditions. These results showed that impacts of ethanol were not as severe as anticipated and imply that ethanol may mitigate the toxicity of TCE to the microorganisms

Within- and between-culture variation: Individual differences and the cultural logics of honor, face, and dignity cultures

Ministry of Education, Singapore under its Academic Research Funding Tier

Plaidoyer pour les antivaleurs

On assiste actuellement à une multiplication de propositions d’« éducations à », dont l’objectif explicite est de faire évoluer les comportements. Mais au nom de quoi ces comportements devraient-ils évoluer ? Sur quels fondements s’appuie-t-on pour disqualifier les attitudes existantes et en légitimer de nouvelles ? Quid de la justification des « éducations à » et de leur forte dimension normative ? Empruntant aussi bien à l’approche analytique anglo-saxonne qu’à l’épistémologie de Canguilhem, cet article vise à justifier une stratégie didactique qui soit propre aux « éducations à ». Il s’appuie pour ce faire sur une analyse du concept de « norme », qui révèle le rôle des antivaleurs pour donner sens aux valeurs. L’éducation au patrimoine, prise entre une justification absolutiste et une justification relativiste des contenus à apprendre, illustrera notre propos.We are currently witnessing a multiplication of “educations for” which explicitly aim to change behaviors. But by what right should these behaviors change? And in the name of what to legitimize new ones? This is the question of justification of “educations for” and their normative dimension which arises here. Borrowing from both the Anglo-Saxon analytical approach and the epistemology of Canguilhem, this article aims to justify a didactic strategy specific to “educations for”. To do this, we will rely on an analysis of the concept of “norm”, which reveals the role of “anti-values” in determining the meaning of values. Heritage education, wedged between an absolutist justification and a relativistic justification, will illustrate our point