Cultural History on the Vanguard for a Sustainable Future: Acequia Communities in Northern New Mexico [abstract]

2 pages

Colonial mutations of caste in Tamil Nadu : an essay on space and untouchability, with special reference to Madurai district, c.1500-1990

After the lengthy war of conquest, the British installed the Permanent Settlement on much of the dry zone of south India. This was part of an original pacification plan designed to be temporary; however, colonial interests later decided that it was politically convenient to maintain some of the "native rank" in the country. These zamindari estates became precisely the area where caste-inducing pseudo-jajmani systems enjoyed a colonized efflorescence. These changes occurred in the nineteenth century; not all of the peculiar traditions of the south Indian social world pre-date the colonial kali yuga

Validating a pain assessment tool in heterogeneous ICU patients: Is it possible?

Non-communicative adult ICU patients are vulnerable to inadequate pain management with potentially severe consequences. In German-speaking countries, there is limited availability of a validated pain assessment tool for this population. Aim The aim of this observational study was to test the German version of the Critical-Care Pain Observation Tool (CPOT) in a heterogeneous adult ICU population. Methods The CPOT's feasibility for clinical use was evaluated via a questionnaire. For validity and reliability testing, the CPOT was compared with the Behavioural Pain Scale (BPS) and patient's self-report in 60 patients during 480 observations simultaneously performed by two raters. Results The feasibility evaluation demonstrated high satisfaction with clinical usability (85% of responses 4 or 5 on a 5-point Likert scale). The CPOT revealed excellent criterion validity [agreement between CPOT and BPS 94.0%, correlation of CPOT and BPS sum scores r = 0.91 (P < .05), agreement of CPOT with patient self-report 81.4%], good discriminant validity [mean difference of CPOT scores between at rest and non-painful stimulus 0.33 (P < .029), mean difference of CPOT scores between at rest, and painful stimulus 2.19 (P < .001)], for a CPOT cut-off score of >2 a high sensitivity and specificity (93% and 84%), high positive predictive value (85%), and a high negative predictive value (93%). The CPOT showed acceptable internal consistency (Cronbach's alpha 0.79) and high inter-rater reliability [90% agreement, no differences in CPOT sum scores in 64.2% of observations, and correlation for CPOT sum scores r = 0.72 (P < .05)]. Self-report obtained in patients with delirium did not correlate with the CPOT rating in 62% of patients. Conclusion This is the first validation study of the CPOT evaluating all of the described validity dimensions, including feasibility, at once. The results are congruent with previous validations of the CPOT with homogeneous samples and show that it is possible to validate a tool with a heterogeneous sample. Further research should be done to improve pain assessment and treatment in ICU patients with delirium

COVID-19 Assessment of a Critically Ill Patient

With the major scale up of critical care services to respond to the increasing numbers of patients with severe COVID-19 infection, nurses need to be able to rapidly assess patients. While many patients present with signs of viral pneumonia and may develop respiratory failure, it is essential that the subsequent systemic complications are also recognized. Due to the unprecedented numbers of patients requiring critical care, many of them will initially have to be managed in the emergency departments and acute wards until a critical care bed becomes available. In this article, the assessment of a patient with suspected or confirmed severe COVID-19 has been presented initially from a ward perspective, followed by that of critical care, using the Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach. This article has been specifically designed to enable nurses to systematically assess patients and prioritise care

Emsden 1955, on to Utah

Photo of Leslie Emsden, a participant in the Eggert-Hatch river expedition down the Green and Colorado Rivers in 1955, standing in front of a pickup truck

Below Green River, Wyoming

Photo of a scene along the Green River below the town of Green River, Wyoming, during the Eggert-Hatch river expedition down the Green and Colorado Rivers in 195

Boats tied to shore

Photo of boats tied to shore along the Green River below the town of Green River, Wyoming, during the Eggert-Hatch river expedition down the Green and Colorado Rivers in 195

Desolation Canyon, Utah

Photo of a scene in Desolation Canyon on the Green River in Utah, during the Eggert-Hatch river expedition down the Green and Colorado Rivers in 195