Improving Systems of Care to Manage Preoperative Anemia in Patients Who Elect to have Total Hip or Total Knee Replacement Surgery

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are surgical procedures performed for painful, dysfunctional joints most often caused by osteoarthritis. These procedures are increasing in demand for not just the elderly, but young adults as well. They are elective procedures associated with a three to five gram decrease in hemoglobin postoperatively, considered a major blood loss. International research results, verified by analysis of a 228 patient sample from the system in this study, demonstrate that patients who enter these procedures with anemia are more likely to require postoperative blood transfusions. With a decreasing supply due to a shrinking donor pool and added costs due to stringent testing, allogeneic blood used for transfusions demands that providers use stewardship with this precious resource. Autologously donated blood as an option is falling out of favor because it further reduces the preoperative hemoglobin, is costly, and unused units are wasted. Blood use for transfusions, whether autologously donated or allogeneic, is associated with many risks including but not limited to fluid volume overload, delayed wound healing, postoperative infections, and longer hospitalizations. Anemia is an abnormal finding and, in the setting of elective surgical procedures with major blood loss, should be corrected preoperatively to decrease the need for blood transfusions. This change project describes interventions to increase red blood cells preoperatively, weaving the interventions into an evidenced-based algorithm for consideration in practice by members of the healthcare team. The evidence-based algorithm and study findings will be shared with providers to invoke discussion on strategies for implementation and evaluation. Furthermore, this project serves as an example of research-guided changes, designed by a doctorally prepared nurse, capable of enhancing positive health care outcomes for both the patient and the healthcare system

DIY academic archiving:Mischievous disruptions of a new counter-movement

Against increasing injunctions in research governance to create open data, and knee-jerk rejections from qualitative researchers in response to such efforts, we explore a radical counter movement of academics engaged in what we term “DIY Academic Archiving,” the creation of open and accessible archives of their research materials. We turn to interviews with three DIY academic archivists, each drawing on an ethos of community archiving, as opposed to emerging open data schemes: Melissa Munn on The Gaucher/Munn Penal Press Collection,1 Eric Gonzaba’s Wearing Gay History,2 and Michael Goodman’s Victorian Illustrated Shakespeare Archive.3 We see these archives as engaged in a “politics of refusal,” which challenges both conventional methods and ethics in qualitative research as well as new moves toward open data. On the one hand, academics are tasked to “protect” their data by destroying it, under the guise of a supposed mode of “care.” On the other hand, open data makes quite contrary demands, to care for data by making it “open” for further extraction through (re)use. DIY Academic Archiving is a practice of refusal that supports a redirection away from this binary. In this article, we explore how DIY academic archivists play with coding as a form of mischievous disruption, and so are contributing to new data imaginaries. We offer insight into how DIY Academic Archiving supports researchers in their theoretical, methodological and political commitments, and at the same time, how it can enable researchers to take the care-full risk of archiving our research data

C/EBPBeta and Elk-1 synergistically transactivate the c-fos serum response element

BACKGROUND: The serum response element (SRE) in the c-fos promoter is a convergence point for several signaling pathways that regulate induction of the c-fos gene. Many transcription factors regulate the SRE, including serum response factor (SRF), ternary complex factor (TCF), and CCAAT/enhancer binding protein-beta (C/EBPβ). Independently, the TCFs and C/EBPβ have been shown to interact with SRF and to respond to Ras-dependent signaling pathways that result in transactivation of the SRE. Due to these common observations, we addressed the possibility that C/EBPβ and Elk-1 could both be necessary for Ras-stimulated transactivation of the SRE. RESULTS: In this report, we demonstrate that Elk-1 and C/EBPβ functionally synergize in transactivation of both a Gal4 reporter plasmid in concert with Gal4-SRF and in transactivation of the SRE. Interestingly, this synergy is only observed upon activation of Ras-dependent signaling pathways. Furthermore, we show that Elk-1 and C/EBPβ could interact both in an in vitro GST-pulldown assay and in an in vivo co-immunoprecipitation assay. The in vivo interaction between the two proteins is dependent on the presence of activated Ras. We have also shown that the C-terminal domain of C/EBPβ and the N-terminal domain of Elk-1 are necessary for the proteins to interact. CONCLUSIONS: These data show that C/EBPβ and Elk-1 synergize in SRF dependent transcription of both a Gal-4 reporter and the SRE. This suggests that SRF, TCF, and C/EBPβ are all necessary for maximal induction of the c-fos SRE in response to mitogenic signaling by Ras

Help Wanted: A Policy Maker's Guide to New Dental Providers (Issue Brief)

Access to oral health care is becoming an increasingly serious problem for many people in the United States, particularly for children. The tragic death of 12-year-old Deamonte Driver in 2007 from complications of untreated tooth decay gave the nation a sobering reminder of the grim consequences that can result from a lack of dental care availability.The National Academy for State Health Policy and the Pew Center on the States, with funding from the W.K. Kellogg Foundation, conducted a comprehensive literature review and interviewed leading experts in several states to learn about options for expanding available care. This issue brief is a summary of the full report

The Mirrored Road

The Mirrored Road is a feature film that explores the relationship between trauma and memory, and questions the function of home movies as a vehicle for truth. The film weaves together family footage shot over the past 70 years, films from Hollywood’s silent era, and new footage shot between 2017–2020

Fashioning labour rights? Understanding the efforts of transnational stakeholders in the responsible fashion and apparel (RFA) movement post-Rana Plaza, Bangladesh

In the wake of the 2013 Rana Plaza building collapse in Savar, Bangladesh, transnational stakeholders and stakeholder groups working within the global movement for responsible fashion and apparel (RFA) mobilised in extraordinary ways, developing and implementing a spectrum of strategies and actions aimed at supporting garment worker safety in Bangladesh. While some focused on building infrastructure, lobbying companies and governments to improve workplace standards through policy and legislation in the country, others sought to improve voluntary corporate standards. These stakeholders make up part of a global movement of individuals and organisations engaged in efforts which aim to both challenge and disrupt conventional systems of fashion and apparel production and consumption with respect to social and environmental issues. Long before Rana Plaza collapsed, transnational stakeholders engaged in efforts directed at improving labour conditions for garment workers in Bangladesh. In this thesis, I examine how RFA movement stakeholders mobilised post-Rana Plaza and consider how fashion was leveraged across the movement as a tool to support the labour rights of garment workers in Bangladesh. Findings stem from data gathered through 42 qualitative interviews conducted with elite RFA movement stakeholders based in Bangladesh, Canada, Europe, the United Kingdom, and the United States, as well as a website analysis of the UK-based ‘pro-fashion’ transnational project Fashion Revolution (FashRev), which operates as an analytic entry point into the wider RFA movement. Captured within the thesis are the views of artists, activists, corporate social responsibility advisors, designers, educators, government officials, and key individuals working at local and international organisations, all connected to fashion-related efforts aimed at supporting labour rights in Bangladesh. By separating research participants into four distinct categories (fashion-based, labour rights organisation-based, industry-based and other-related stakeholders), differences and similarities between stakeholder groups emerge. Within this thesis I show how RFA movement stakeholders, despite working in diverse and divergent capacities, share a theory of change regarding aspirations to support labour rights. The thesis also reveals that across the movement, stakeholders leverage similar tools to achieve their aims. Operating within an information provision reform pathway, research participants understood knowledge exchange and resource sharing as central in their efforts to better support garment workers. Calling for reform through voluntary and legislative means, stakeholders leveraged fashion, strategic partnerships, and digital technologies to assist them in their endeavours. Responding to the collapse, the majority of transnational efforts mimicked previous strategies and tactics. The thesis reveals that there is more nuance to efforts at work within the movement, as some stakeholders engaged with fashion as a tool for disruption to challenge conventional understandings related to fashion and apparel production and consumption under the logic of capitalism

Performance of sanitary sewer collection system odour control devices operating in diverse conditions

Controlling odours from sanitary sewer systems is challenging as a result of the expansive nature of these systems. Addition of oxidizing chemicals is often practiced as a mitigation strategy. One alternative is to remove odorous compounds in the gases vented from manholes using adsorptive media. In this study, odour control devices located at manholes were observed to determine the ability of these systems to reduce hydrogen sulphide from vented gases. The odour control devices incorporated pressure regulation to control gas flow out of manhole covers and adsorptive media to remove hydrogen sulphide in the vented gases prior to release. Pressure regulation was accomplished using a variable volume bladder and two pressure relief valves that permitted gas flow when pressures exceeded 1.3 to 2.5 cm water column. The reduction in gas flow vented from manholes was intended to extend the service life of the adsorptive media, as compared with odour control devices that do not incorporate pressure modulation. Devices were deployed at four locations and three adsorptive media were tested. Although measured collection system hydrogen sulphide concentrations varied from zero to over 1,000 ppm, the removal rates observed using odour control devices were typically above 90%. The lower removal rates observed at one of the sites (50.5 ± 36.1%) appeared related to high gas flow rates being emitted at this location. Activated carbon was used in most of the tests, although use of iron media resulted in the highest removal observed: 97.8 ± 3.6%. The expected service life of the adsorptive media contained within the odour control devices is a function of site-specific hydrogen sulphide concentrations and gas flow rates. The units used in this study were in service for more than 8 to 12 months prior to requiring media replacement

Stress and resilience during pregnancy: A comparative study between pregnant and non-pregnant women in Ethiopia

BACKGROUND: Stress during pregnancy is associated with perturbances in maternal psychology and physiology, and results in adverse pregnancy and birth outcomes. However, little attention has been given to understand maternal stress and its potential negative consequences in many low- and middle-income countries. We aimed to investigate whether pregnancy is associated with greater stress and lower psychological resilience among women living in Jimma, Southwest Ethiopia. METHOD: An institution-based comparative cross-sectional study design was implemented in Jimma University Medical Center and Jimma health centers from 15 September to 30 November 2021. Women attending antenatal care and family planning services were invited to participate in the study. Participants were interviewed using the Perceived Stress Scale (PSS-10), Brief Resilience Scale (BRS), distress questionnaire-5, and the Household Food Insecurity Access Scale (HFIAS). Linear regression analysis was used to test associations between pregnancy (exposure) and outcomes of interest (stress and resilience scores), while adjusting for potential confounders. Stress and resilience were mutually adjusted for one another in the final model. RESULTS: A total of 166 pregnant and 154 non-pregnant women participated, with mean age of 27.0 SD 5.0 and 29.5 SD 5.3 years respectively. Pregnancy was associated with increased stress score by 4.1 points (β = 4.1; 95% CI: 3.0, 5.2), and with reduced resilience by 3.3 points (β = -3.3; 95% CI: -4.5, -2.2) in a fully adjusted model. In mutually-adjusted models, pregnancy was independently associated with greater stress (β = 2.9, 95% CI 1.8, 3.9) and lower resilience (β = -1.3, 95% CI: -2.5, -0.2) compared to non-pregnant women. CONCLUSION: In this low income setting, pregnancy is associated with greater vulnerability in the mental health of women, characterized by greater perceived stress and diminished resilience. Context-relevant interventions to improve resilience and reduce stress could help improve the health and wellbeing of mothers, with potential benefits for their offspring