Implementation and Evaluation of Critical Care Pain Observation Tool (CPOT)

Background: Pain assessment in critically ill patients using an evidence-based and reliable tool is crucial in providing pain management and promoting recovery of the patients in the Intensive Care Units (ICU). Inadequate pain management can have short-term and long-term complications. Critical Care Pain Observation Tool (CPOT) has been rigorously tested and has been recommended as a valid and reliable pain assessment tool by the Society of Critical Care Medicine and the American Association of Critical Care Medicine.Objective: To implement CPOT and evaluate the impacts of CPOT implementation in the ICUs at NorthBay Medical Center and Vacavalley Hospital. Methods: This evidence-based project utilized the IOWA Model of evidence-based practice change to implement CPOT. Nurses were provided education on CPOT for twenty minutes during mandatory quarterly ICU skills fairs in November 2017. The CPOT was implemented in both ICUs in April 2018. A descriptive study design was used to compare the before and after implementation groups. Forty patient charts were reviewed from the pre-implementation group and another forty patient charts were reviewed from the post-implementation group. Data was collected on number of pain assessments, pain reports, pain reassessments, amount of analgesia administered, ventilator days, and ICU days. Nursing feasibility and applicability survey were collected during pre-implementation and two months’ post-implementation.Results: An inter-rater reliability of 93.3% from thirty pain observations was obtained during the pilot trial. There were no significant differences found between pre-and post-implementation groups in regards to pain assessment frequency, pain reports, analgesia usage, ventilator days, and ICU days. However, there was a statistically significant increase in the pain reassessment frequency (t=2.22, p=0.02). The mean of frequency of pain reassessment was 0.55 for the preimplementation group and 1.425 for the post-implementation group. Nursing survey results showed positive evaluations for CPOT with 100% of the nurses agreeing that CPOT is easy to use and 100% of the nurses agreed that they received adequate CPOT education. 95.9% of the nurses believed that CPOT helped to assess pain accurately in critically ill adult patients on ventilator and 93.8% believed that CPOT positively influenced their practice

Determining major climatic factors and their variations in the central agricultural region of Mongolia

Non-Peer ReviewedIn accordance of the World Meteorological Organization, the weather conditions between 1961 and 1990 is defined as the climate and mean of climatic factors over that time-period is considered as the climatic normal. Climate is formed as a result of interactions between atmosphere, hydrosphere, lithosphere (geosphere), biosphere, and cryosphere. It develops and changes due to various external factors, periodic and non-periodic fluctuations in these systems. Number of studies has shown some strong indications of global warming in Mongolia. Objective of this study was to determine the changes and trends in the major climatic factors such as annual air temperature and precipitation in Orkhon-Selenge Basin, the Central Agricultural Region of Mongolia, over the last 15 years (1991-2006). Our study has revealed that over the past 15 years, from 1991 to 2006, the mean annual air temperature in the Central Agricultural Region of Mongolia has risen by 0.7-1.2 degrees Celsius or 0.04-0.07 degrees Celsius per year. Consequently, there has been higher frequency of years exhibiting drought like conditions negatively impacting vegetation growth. The warming has been causing a higher frequency of occurrence of drier years with moisture deficit for vegetation growth

The Fruit Flies (Diptera, Tephritidae) in Bhutan: New Faunistic Records and Compendium of Fauna

Based on a field survey from 2017, twenty-three species are reported from Bhutan for the first time: Acroceratitis ceratitina, A. hardyi, Anomoia approximata, Bactrocera connecta, B. latifrons, B. nigrifacia, B. syzygii, Campiglossa sororcula, Cecidochares connexa, Dacus jacobi, Gastrozona fasciventris, Hoplandromyia antelopa, Lenitovena ultima, Ptilona confinis, Rioxoptilona dunlopi, R. formosana, R. vaga, Spathulina acroleuca, Themara yunnana, Trypeta indica, Zeugodacus apiciflavus, Z. diversus, and Z. fereuncinatus. Four species of the genera Cornutrypeta, Hemilea, Morinowotome, and Vidalia are also recorded for the first time, but the precise determination to species needs additional study and material. As the result, 71 species is listed from Bhutan by far. Their taxonomic position and key characters are discussed. Illustrations for most of the newly recorded species are given

Probabilistic adaptive model predictive power pinch analysis (PoPA) energy management approach to uncertainty

This paper proposes a probabilistic power pinch analysis (PoPA) approach based on Monte–Carlo simulation (MCS) for energy management of hybrid energy systems uncertainty. The systems power grand composite curve is formulated with the chance constraint method to consider load stochasticity. In a predictive control horizon, the power grand composite curve is shaped based on the pinch analysis approach. The robust energy management strategy effected in a control horizon is inferred from the likelihood of a bounded predicted power grand composite curve, violating the pinch. Furthermore, the response of the system using the energy management strategies (EMS) of the proposed method is evaluated against the day-ahead (DA) and adaptive power pinch strategy

Educating Health Professionals about Disability: A Review of Interventions

Health professionals need to understand the human rights and health needs of disabled people. This review of evidence on interventions demonstrates that a range of often innovative approaches have been trialled. Lectures by faculty are less effective in changing attitudes than contact with disabled people themselves. Existing examples of good practice need to be scaled up, and better and more long-term evaluations of impact are required

Expression of mitochondrial protein genes encoded by nuclear and mitochondrial genomes correlate with energy metabolism in dairy cattle

Background Mutations in the mitochondrial genome have been implicated in mitochondrial disease, often characterized by impaired cellular energy metabolism. Cellular energy metabolism in mitochondria involves mitochondrial proteins (MP) from both the nuclear (NuMP) and mitochondrial (MtMP) genomes. The expression of MP genes in tissues may be tissue specific to meet varying specific energy demands across the tissues. Currently, the characteristics of MP gene expression in tissues of dairy cattle are not well understood. In this study, we profile the expression of MP genes in 29 adult and six foetal tissues in dairy cattle using RNA sequencing and gene expression analyses: particularly differential gene expression and co-expression network analyses. Results MP genes were differentially expressed (DE; over-expressed or under-expressed) across tissues in cattle. All 29 tissues showed DE NuMP genes in varying proportions of over-expression and under-expression. On the other hand, DE of MtMP genes was observed in < 50% of tissues and notably MtMP genes within a tissue was either all over-expressed or all under-expressed. A high proportion of NuMP (up to 60%) and MtMP (up to 100%) genes were over-expressed in tissues with expected high metabolic demand; heart, skeletal muscles and tongue, and under-expressed (up to 45% of NuMP, 77% of MtMP genes) in tissues with expected low metabolic rates; leukocytes, thymus, and lymph nodes. These tissues also invariably had the expression of all MtMP genes in the direction of dominant NuMP genes expression. The NuMP and MtMP genes were highly co-expressed across tissues and co-expression of genes in a cluster were non-random and functionally enriched for energy generation pathway. The differential gene expression and co-expression patterns were validated in independent cow and sheep datasets. Conclusions The results of this study support the concept that there are biological interaction of MP genes from the mitochondrial and nuclear genomes given their over-expression in tissues with high energy demand and co-expression in tissues. This highlights the importance of considering MP genes from both genomes in future studies related to mitochondrial functions and traits related to energy metabolism

Impact of COVID-19 on mental health in Bhutan: a way forward for action

The coronavirus disease 2019 (COVID-19) pandemic continues to impact mental health and wellbeing globally. There is a lack of scientific documentation highlighting the mental health impact of COVID-19 in Bhutan. We present the mental health burdens and control measures taken, and suggest ways to further strengthen mental health services in Bhutan. During the pandemic, a rise in depression and anxiety had been reported in Bhutan. Depression rose from an average prevalence of 9 per 10,000 between 2011 and 2019 to 16 per 10,000 in 2020 and 32 per 10,000 in 2021. Similarly, anxiety rose from an average prevalence of 18 per 10,000, to 29 per 10,000 in 2020, and 55 per 10,000 in 2021. Psychological impacts related to isolation due to lockdowns, economic losses, and poor coping abilities were associated with negative outcomes. Stigma and discrimination towards mental health disorders discouraged mentally distressed people from seeking care. In response to increased demand, Bhutan's government initiated a range of interventions including home delivery of medicines and tele-counselling to people in need of urgent mental health care. Mental health care in Bhutan can be further improved through investment in services and human resources, and decentralization of services to the community