Impact of an Advanced Cardiac Life Support Process Improvement Initiative on Leadership Role Comfort

Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED) requires optimized advanced cardiac life support (ACLS). An ACLS leader monitors compressions, orders medications, performs rhythm checks, directs defibrillation, and times events. This role was reassigned from physicians to nurses. Nurse led ACLS may allow physicians to assess ECPR inclusion criteria. There is limited research on ACLS leader role comfort for nurses. We hypothesized an ECPR initiative in the ED would improve personnel comfort in the ACLS leader role. ECPR initiative implementation included didactics and simulation training. A survey was distributed to ED residents, attending physicians, and nurses, and included six Likert-scale items on comfort with the ACLS leader role. Surveys were administered 6 months prior to and 3 months after implementation. There were 91 respondents at baseline and 100 respondents in the follow-up, resulting in a 43% and 48% response rate, respectively. We used Mann-Whitney tests to compare ordinal variables and non-parametric tests to assess the impact of initiative completion and level of experience on a cumulative score for comfort. We observed no significant changes for the six comfort items from the baseline survey regardless of respondent group. In the post-period, nurses (22.6/30) and resident physicians (23.9/30) had significantly lower mean cumulative comfort scores when compared to attending physicians (27.5/30) (p\u3c .001). Experience leading ACLS in the past 12 months was a significant predictor of cumulative comfort score for nurses in the post-period (p = .029), even when completion of ECPR requirements was controlled. While most report comfort acting in the role of ACLS leader there was no significant improvement post-initiative. These findings, combined with the significance of experience leading ACLS on comfort for nurses and resident physicians, suggest continued experiential learning and opportunities for simulation

Integrase-RNA interactions underscore the critical role of integrase in HIV-1 virion morphogenesis

A large number of human immunodeficiency virus 1 (HIV-1) integrase (IN) alterations, referred to as class II substitutions, exhibit pleiotropic effects during virus replication. However, the underlying mechanism for the class II phenotype is not known. Here we demonstrate that all tested class II IN substitutions compromised IN-RNA binding in virions by one of the three distinct mechanisms: (i) markedly reducing IN levels thus precluding the formation of IN complexes with viral RNA; (ii) adversely affecting functional IN multimerization and consequently impairing IN binding to viral RNA; and (iii) directly compromising IN-RNA interactions without substantially affecting IN levels or functional IN multimerization. Inhibition of IN-RNA interactions resulted in the mislocalization of viral ribonucleoprotein complexes outside the capsid lattice, which led to premature degradation of the viral genome and IN in target cells. Collectively, our studies uncover causal mechanisms for the class II phenotype and highlight an essential role of IN-RNA interactions for accurate virion maturation

La Grange Comprehensive Plan 2018 - 2038

In the Fall of 2017, the City of La Grange and Texas Target Communities partnered to create a task force to represent the community. The task force was integral to the planning process, contributing the thoughts, desires, and opinions of community members—as well as their enthusiasm about La Grange’s future. This fifteen-month planning process ended in August 2018. The result of this collaboration is the La Grange Comprehensive Plan, which is the official policy guide for the community’s growth over the next twenty years.La Grange Comprehensive Plan 2018 - 2038 provides a guide for the future growth of the City. This document was developed by Texas Target Communities in partnership with the City of La Grange.Texas Target Communitie

Global standards of Constitutional law : epistemology and methodology

Just as it led the philosophy of science to gravitate around scientific practice, the abandonment of all foundationalist aspirations has already begun making political philosophy into an attentive observer of the new ways in which constitutional law is practiced. Yet paradoxically, lawyers and legal scholars are not those who understand this the most clearly. Beyond analyzing the jurisprudence that has emerged from the expansion of constitutional justice, and taking into account the development of international and regional law, the ongoing globalization of constitutional law requires comparing the constitutional laws of individual nations. Following Waldron, the product of this new legal science can be considered as ius gentium. This legal science is not as well established as one might like to think. But it can be developed on the grounds of the practice that consists in ascertaining standards. As abstract types of best “practices” (and especially norms) of constitutional law from around the world, these are only a source of law in a substantive, not a formal, sense. They thus belong to what I should like to call a “second order legal positivity.” In this article I will undertake, both at a methodological and an epistemological level, the development of a model for ascertaining global standards of constitutional law

Rockport Comprehensive Plan

This document was developed and prepared by Texas Target Communities (TxTC) at Texas A&M University in partnership with the City of Rockport, Texas Sea Grant, Texas A&M University - Corpus Christi, Texas A&M University - School of Law and Texas Tech University.Founded in 1871, the City of Rockport aims to continue growing economically and sustainably. Rockport is a resilient community dedicated to sustainable growth and attracting businesses to the area. Rockport is a charming town that offers a close-knit community feel and is a popular tourist destination for marine recreation, fairs, and exhibitions throughout the year. The Comprehensive Plan 2020-2040 is designed to guide the city of Rockport for its future growth. The guiding principles for this planning process were Rockport's vision statement and its corresponding goals, which were crafted by the task force. The goals focus on factors of growth and development including public participation, development considerations, transportation, community facilities, economic development, parks, and housing and social vulnerability

Systematic review of the evidence relating FEV1 decline to giving up smoking

<p>Abstract</p> <p>Background</p> <p>The rate of forced expiratory volume in 1 second (FEV₁) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta.</p> <p>Methods</p> <p>Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors.</p> <p>Results</p> <p>Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex.</p> <p>Conclusion</p> <p>The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV₁decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.</p

From Aziridines to Daffodils: Development of an Oxidative Insertion for the Synthesis of Isoquinolone Derivatives

In the construction of many natural products, the isoquinolone backbone serves as a challenging functionality to incorporate into a total synthesis. Recent publications have shown that metal-catalyzed intramolecular addition of nitrogen can be achieved with allyl-substituted sulfonamides and carbamates. With this knowledge, we endeavored to provide a new synthetic pathway using dirhodium catalysts, to achieve N-insertion resulting in the desired isoquinolone functionality. Various dirhodium carboxamidate and carboxylate catalysts were efficiently prepared via microwave heating with high yields. Known procedures were adapted for simplified preparations saving time and resources. Results of the oxidative insertion and rearrangement are reported of the benzamide derivatives as well as successful N-H insertion of other benzyl carbamates. While intramolecular aziridination of benzamide derivatives was not achieved, we continue to investigate the oxidative insertion with similar carbamate derivatives

Daniel Streeter, Charles P. Curtis, and Stewart White in \u3cem\u3eGreen Hills of Africa\u3c/em\u3e

Source study on the influence of popular safari authors on the tone, characterization, and subject matter of Hemingway’s 1935 safari narrative. Briefly comments on Mark Twain’s contributions to the travel literature tradition