Exploring the Enteral Feeding Practices Used by Critical Care Nurses: A Dissertation

Mechanically ventilated critically ill patients treated in the intensive care unit (ICU) require enteral feedings to maintain adequate nutrition during critical illness. Delivery of adequate enteral nutrition is also critical to the recovery of critically ill patients. Enteral nutrition has been shown to decrease length of time on the ventilator, decrease length of stay and ICU and decrease mortality. Despite all the evidence regarding the benefits of enteral nutrition, critically ill patients continue to receive less than their prescribed calories and protein. Nurses are in a unique position to influence the delivery of enteral nutrition. Nursing practices that contribute to underfeeding must be identified and corrected to ensure adequate delivery of nutrients is achieved. The purpose of the study was to describe the professional practice of critical care nurses regarding enteral feeding in mechanically ventilated critically ill patients. Several barriers were identified by the participants in the study that contributed to underfeeding including inconsistent practice regarding gastric residual volume, holding feeds when changing patient position and lack of a standardized protocol for enteral feeding. Also identified in the study was the idea that nurses do not see enteral feeding as a life-saving intervention. It is not the “sexy part” of what ICU nurses do. Enteral feeding guidelines need to be developed to include those interventions that are important to nursing practice in order to increase enteral feeding times and improve patient outcomes

West of Wichita: Settling the High Plains of Kansas, 1865-1890.

Craig Miner\u27s new book is a social history of the settlement of a specific Western region. In methodology and manner of presentation it resembles other new social histories. It is interdisciplinary and based on the social scientists\u27 modeling techniques. Miner cites European historians and, what is more remarkable, one can imagine them citing him. He uses unconventional primary materialsmanuscript censuses, tax records, and the reminiscences of the ordinary people whose story he tells; he concentrates on the material lives of those people, the fellows at the bottom, Bertolt Brecht called them, the ones, according to T. E. Lawrence who did not write the dispatches. His focus is, perforce, regional. Social history does not permit of broad historical canvases splashed with unsupported and often meaningless generalizations. Its practitioners understand that nets cast deeply yield more than those cast widely, that the scope of the topic does not determine the significance of a book but rather the intelligence with which the topic is explored and the care with which its lessons are applied

State of Montana v. Atlantic Richfield Company No. CV-83-317-HLN-PGH: Expert Report of David M. Emmons

This report discusses the history of metal mining and processing in the Upper Clark Fork watershed (Montana) written by David M. Emmons, Ph.D., and submitted as evidence in the case State of Montana v. Atlantic Richfield Company in 1995.https://scholarworks.umt.edu/emmons/1000/thumbnail.jp

West of Wichita: Settling the High Plains of Kansas, 1865-1890.

Craig Miner\u27s new book is a social history of the settlement of a specific Western region. In methodology and manner of presentation it resembles other new social histories. It is interdisciplinary and based on the social scientists\u27 modeling techniques. Miner cites European historians and, what is more remarkable, one can imagine them citing him. He uses unconventional primary materialsmanuscript censuses, tax records, and the reminiscences of the ordinary people whose story he tells; he concentrates on the material lives of those people, the fellows at the bottom, Bertolt Brecht called them, the ones, according to T. E. Lawrence who did not write the dispatches. His focus is, perforce, regional. Social history does not permit of broad historical canvases splashed with unsupported and often meaningless generalizations. Its practitioners understand that nets cast deeply yield more than those cast widely, that the scope of the topic does not determine the significance of a book but rather the intelligence with which the topic is explored and the care with which its lessons are applied

Quantitative observations of the behavior of anomalous low altitude ClO in the Antarctic spring Stratosphere, 1987

During the second National Ozone Expedition ground-based observations at McMurdo Station Antarctica were performed which resulted in a second season's measurement of abnormally large amounts of ClO in the Antarctic spring stratosphere. The original measurements of 1986, in which the presence of this anomalous layer was first discovered, were limited in low altitude recovery of the ClO mixing ratio profile by the restrictions of the spectral bandwidth (256 MHz) which was used to measure the pressure-broadened ClO emission line shape. The 1987 measurements were marked by the use of twice the spectral bandpass employed the previous year, and allow a better characterization of the ClO mixing ratio profile in the critical altitude range 18 to 25 km. In-situ aircraft measurements of ClO made over the Palmer Peninsula during Aug. and Sept. of 1987 by Anderson, et al. effectively determined the important question of the ClO mixing ratio profile at altitudes inaccessible to our technique, below approximately 18 to 18.5 km. These flights did not penetrate further than 75 deg S, however, (vs 78 deg S for McMurdo) and were thus limited to coverage near the outer boundaries of the region of severest ozone depletion over Antarctica in 1987, did not reach an altitude convincingly above that of the peak mixing ratio for ClO, and were not able to make significant observations of the diurnal variation of ClO. The two techniques, and the body of data recovered by each, thus complement one another in producing a full picture of the anomalous ClO layer intimately connected with the region of Antarctic spring ozone depletion. An analysis is presented of the mixing ratio profile from approximately 18 to 45 km, the diurnal behavior, and the secular change in ClO over McMurdo Station during Sept. and early Oct. 1987

Daytime ClO over McMurdo in September 1987: Altitude profile retrieval accuracy

During the 1987 National Ozone Expedition, mm-wave emission line spectra of the 278.6 GHz rotational stratospheric ClO were observed at McMurdo Station, Antarctica. The results confirm the 1986 discovery of a lower stratospheric layer with approximately 100 times the normal amount of ClO; the 1987 observations, made with a spectrometer bandwidth twice that used in 1986, make possible a more accurate retrieval of the altitude profile of the low altitude component of stratospheric ClO from the pressure broadened line shape, down to approximately 16 km. The accuracy of the altitude profile retrievals is discussed, using the daytime (09:30 to 19:30, local time) data from 20 to 24 September, 1987 as an example. The signal strength averaged over this daytime period is approx. 85 percent of the midday peak value. The rate of ozone depletion implied by the observed ClO densities is also discussed

Independent Orbiter Assessment (IOA): Analysis of the orbiter main propulsion system

The results of the Independent Orbiter Assessment (IOA) of the Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL) are presented. The IOA approach features a top-down analysis of the hardware to determine failure modes, criticality, and potential critical items (PCIs). To preserve independence, this analysis was accomplished without reliance upon the results contained within the NASA FMEA/CIL documentation. The independent analysis results for the Orbiter Main Propulsion System (MPS) hardware are documented. The Orbiter MPS consists of two subsystems: the Propellant Management Subsystem (PMS) and the Helium Subsystem. The PMS is a system of manifolds, distribution lines and valves by which the liquid propellants pass from the External Tank (ET) to the Space Shuttle Main Engines (SSMEs) and gaseous propellants pass from the SSMEs to the ET. The Helium Subsystem consists of a series of helium supply tanks and their associated regulators, check valves, distribution lines, and control valves. The Helium Subsystem supplies helium that is used within the SSMEs for inflight purges and provides pressure for actuation of SSME valves during emergency pneumatic shutdowns. The balance of the helium is used to provide pressure to operate the pneumatically actuated valves within the PMS. Each component was evaluated and analyzed for possible failure modes and effects. Criticalities were assigned based on the worst possible effect of each failure mode. Of the 690 failure modes analyzed, 349 were determined to be PCIs