Nurse-Initiated Protocols for Chest Pain in the Emergency Department

Practice Problem: Emergency department crowding inhibits the ability to provide safe patient care to chest pain patients and negatively impact patient outcomes. A Veteran Affairs emergency department has identified a similar concern and implemented a nurse-initiated protocol to decrease the length of stay and improve patient outcomes. PICOT: This evidence-based practice (EBP) project was guided by the following PICOT question: In the emergency department (ED), how does a nurse-initiated protocol (NIP) for chest pain (CP) patients compared to no protocol use influence length of stay (LOS) in the ED over 8 weeks? Evidence: The reviewed literature supported the evidence of effective use of a nurse-initiated protocol in reducing the length of stay in the emergency department. Eleven articles met the inclusion criteria and were used for this literature review. Intervention: The evidence-based nurse-initiated protocol is an intervention to provide objective clinical practice guidelines for chest pain patients resulting in improved earlier diagnostic results and decreased length of stay in the emergency department. Outcome: Post-implementation conclusions revealed no reduction in length of stay after using the protocol but achieved a clinically significant decrease in the time of completion for 12-lead EKGs. Conclusion: Staff education and the implementation of an evidence-based NIP for CP established positive outcomes on reducing EKG times. The results were also clinically significant to validate the implementation of nursing protocols in the ED for decreasing LOS and improving patient outcomes

Replacing Cottonseed Meal and Sorghum Grain with Corn Dried Distillers Grains with Solubles in Lamb Feedlot Diets: Growth Performance, Rumen Fluid Parameters, Blood Serum Chemistry, Carcass Characteristics, and Sensory Panel Traits

Effects of replacing cottonseed meal (CSM) and sorghum grain with dried distillers grains with solubles (DDGS) in Dorper ram lamb (n = 46) feedlot diets on growth performance, rumen fluid parameters, and blood serum chemistry were evaluated. In a randomized design study, lambs were individually fed ad libitum 70.9% concentrate diets for 56-d in individual pens. The positive control diet (CNTL) contained CSM, sorghum grain, and other concentrates, but no DDGS. Four treatment diets were similar to CNTL, but did not contain CSM. Corn DDGS replaced 0% (0DDGS), 33% (33DDGS), 66% (66DDGS) or 100% (100DDGS) of the sorghum grain in the treatment diets. At 48-h postmortem, the longissimus thoracis was removed from the carcass, frozen, thawed, cooked, and evaluated by a trained sensory panel. Lambs fed CNTL were compared to 0DDGS and linear and quadratic effects were evaluated within the four DDGS diets. A treatment × day interaction was observed (P < 0.001) for lamb BW, but not for ADG, DMI, or G:F (P ≥ 0.78). Lambs fed CNTL had greater (P 0.02) BW on d 42 and 56 and greater (P < 0.008) overall ADG and G:F than lambs fed 0DDGS. On d 42 and 56, lamb BW quadratically increased (P 0.04) as DDGS increased in the diet. Averaged across all days, ADG quadratically increased (P < 0.001) and DMI and G:F tended to quadratically increase (P 0.08) as DDGS increased in the diet. On d 56, ruminal pH quadratically decreased (P < 0.001), ruminal ammonia N quadratically increased (P < 0.001), acetate linearly increased (P < 0.001), and acetate:propionate tended to linearly increase (P = 0.08) as DDGS increased in the diet. Various blood serum profiles were affected by diet, but data suggested that diet did not negatively affect lamb health. Lambs fed CNTL had greater (P ≤ 0.03) hot carcass weight (HCW) and ribeye area (REA) than lambs fed 0DDGS. As DDGS incrementally replaced sorghum grain, HCW and flank fat quadratically increased (P ≤ 0.05), marbling linearly decreased (P = 0.03), rib eye area tended to linearly increase (P = 0.06), and skeletal maturity tended to linearly decrease (P = 0.06). No differences in sensory panel traits were observed (P 0.06) between lambs fed CNTL or 0DDGS. As DDGS incrementally replaced sorghum grain, juiciness linearly increased (P = 0.03), cook loss quadratically increased (P = 0.05), lamb flavor identity tended to quadratically increase (P = 0.09) and certain flavor attributes quadratically increased (brown, roasted, umami; P ≤ 0.03), quadratically decreased (metallic; P = 0.004), or linearly increased (bloody; P = 0.003). Results indicated that lamb growth performance is enhanced when CSM is used to increase dietary CP (CNTL vs. 0DDGS) and that the 66DDGS diet resulted in the greatest growth performance. Results also indicated that carcass and sensory characteristics are not negatively affected (some are enhanced) when DDGS replaces CSM and sorghum grain in Dorper lamb feedlot diets

Green Roofs in the Garden City: Exploring the Opportunities for Green Roof Policies in Missoula, Montana

Global climate change is expected to have adverse impacts on the Rocky Mountain West, including impacts on water and land use, energy consumption, weather patterns, and wildlife stewardship. The State of Montana, Missoula County and the City of Missoula all have recognized these threats and are taking steps to address climate change impacts. In response to the unique challenges posed by urban environments, the practice of green, or vegetative, roofing has been promoted through policy measures by a number of cities in the United States and abroad. This project explores green roofing and the policies used to encourage the practice with the goal of recommending what kind of green roof policy, if any, would be politically and practically feasible in the City of Missoula. This project explores the practice of green roofing through a discussion of its history and the benefits green roofs offer to building owners and communities. It explores three obstacles to widespread green roof adoption. It introduces the six main green roof policy tools identified through research, and presents eight case examples of cities with green roof policies in place to gain an understanding of these programs’ goals, the policy measures employed, and how successful these policies have been. It presents interview data from fourteen interviews with twenty-two Missoula-area stakeholders from four stakeholder groups: City administrators, architecture, design and building organizations, the conservation community, and others. These groups are analyzed to determine whether they support the City of Missoula taking policy steps to encourage green roofing, and to determine these groups’ preferred policy tools. Based on this research, the project concludes with six recommendations as to how the City of Missoula can best promote the practice of green roofing: educating residents and building owners; pursuing a City-lead green roof demonstration project; establishing standards for green roofs in the Missoula Building Code; passing a nonbinding resolution in favor of green roofing; committing to a strong sustainable building policy for City buildings; and offering nonmonetary incentives for green roof installation

Streaking into the history books

It wasn’t the stuff of Hollywood movie legend. There was no last-second shot to win a championship, Hail Mary pass to win the big game or inspirational halftime speech to rally a team of lovable but scrappy underdogs

Fast Neutron Detection in Nuclear Material Photofission Assay Using a 15 MeV Linear Electron Accelerator

The purpose of this research was to use a 15 MeV (K15 model by Varian) linear electron accelerator (linac) for the photon assay of special nuclear materials (SNM). First, the properties of the photon radiation probe were determined. The stochastic radiation transport code, MCNP5, was used to develop computational models for the linac. The spectral distribution of photons as well as dose rate contour maps of the UNLV accelerator facility were computed for several linac operating configurations. These computational models were validated through comparison with experimental measurements of dose rates. The linac model was used to simulate the photon interrogation of SNM targets of various compositions and shielding materials. The spectra of neutrons produced by the irradiation of shielded SNM was characterized. The effects of shielding material and the SNM enrichment on the neutron yields following photon assay were determined. It was determined that the radiation signatures following the photon assay of SNM consisted of photons and neutrons produced from the fissions, in addition to neutrons produced from photonuclear reactions. The EJ-299-33A plastic scintillator was evaluated for this study due to its ability to discriminate between fast neutrons and gamma rays. The neutron coincidence measurement option was also evaluated. The detector response functions were determined for different incident neutron energies. Further, it was computationally shown that an array of EJ-299-33A detectors allows to measure neutron multiplicity, enabling discrimination between fission neutrons and the photoneutrons

Replacing Cottonseed Meal and Sorghum Grain with Corn Dried Distillers Grains with Solubles in Lamb Feedlot Diets: Growth Performance, Rumen Fluid Parameters, Blood Serum Chemistry, Carcass Characteristics, and Sensory Panel Traits

Effects of replacing cottonseed meal (CSM) and sorghum grain with dried distillers grains with solubles (DDGS) in Dorper ram lamb (n = 46) feedlot diets on growth performance, rumen fluid parameters, and blood serum chemistry were evaluated. In a randomized design study, lambs were individually fed ad libitum 70.9% concentrate diets for 56-d in individual pens. The positive control diet (CNTL) contained CSM, sorghum grain, and other concentrates, but no DDGS. Four treatment diets were similar to CNTL, but did not contain CSM. Corn DDGS replaced 0% (0DDGS), 33% (33DDGS), 66% (66DDGS) or 100% (100DDGS) of the sorghum grain in the treatment diets. At 48-h postmortem, the longissimus thoracis was removed from the carcass, frozen, thawed, cooked, and evaluated by a trained sensory panel. Lambs fed CNTL were compared to 0DDGS and linear and quadratic effects were evaluated within the four DDGS diets. A treatment × day interaction was observed (P < 0.001) for lamb BW, but not for ADG, DMI, or G:F (P ≥ 0.78). Lambs fed CNTL had greater (P 0.02) BW on d 42 and 56 and greater (P < 0.008) overall ADG and G:F than lambs fed 0DDGS. On d 42 and 56, lamb BW quadratically increased (P 0.04) as DDGS increased in the diet. Averaged across all days, ADG quadratically increased (P < 0.001) and DMI and G:F tended to quadratically increase (P 0.08) as DDGS increased in the diet. On d 56, ruminal pH quadratically decreased (P < 0.001), ruminal ammonia N quadratically increased (P < 0.001), acetate linearly increased (P < 0.001), and acetate:propionate tended to linearly increase (P = 0.08) as DDGS increased in the diet. Various blood serum profiles were affected by diet, but data suggested that diet did not negatively affect lamb health. Lambs fed CNTL had greater (P ≤ 0.03) hot carcass weight (HCW) and ribeye area (REA) than lambs fed 0DDGS. As DDGS incrementally replaced sorghum grain, HCW and flank fat quadratically increased (P ≤ 0.05), marbling linearly decreased (P = 0.03), rib eye area tended to linearly increase (P = 0.06), and skeletal maturity tended to linearly decrease (P = 0.06). No differences in sensory panel traits were observed (P 0.06) between lambs fed CNTL or 0DDGS. As DDGS incrementally replaced sorghum grain, juiciness linearly increased (P = 0.03), cook loss quadratically increased (P = 0.05), lamb flavor identity tended to quadratically increase (P = 0.09) and certain flavor attributes quadratically increased (brown, roasted, umami; P ≤ 0.03), quadratically decreased (metallic; P = 0.004), or linearly increased (bloody; P = 0.003). Results indicated that lamb growth performance is enhanced when CSM is used to increase dietary CP (CNTL vs. 0DDGS) and that the 66DDGS diet resulted in the greatest growth performance. Results also indicated that carcass and sensory characteristics are not negatively affected (some are enhanced) when DDGS replaces CSM and sorghum grain in Dorper lamb feedlot diets

What the past holds in store: an anthropological study of temporality in a southern French village

This thesis examines the diverse and conflicting ways in which the past is invoked in a village in the coastal area of the Aude department, in the Languedoc region of Southern France. The region of Languedoc has been undergoing turbulent, and unpredictable socio-economic change since the development of viticultural capitalism in the 19th century, and since the 1960s has also witnessed the development of a sizeable tourist industry. These factors, along with the proximity of the village to the city of Narbonne, have led over the past 150 years to the creation of a heterogeneous village population. The thesis details the plurality of ways in which the past was temporalised in the village during the fieldwork period (1996-7), taking account of the various social groups present in the village, and their economic activities and life worlds. It also illustrates the relationship between local temporalities and wider socio-economic developments in the region, in particular in relation to the development of a tourist industry that transforms the past into a commodity. The thesis is partly concerned to assess the relationship between these wider socio-economic developments, and the sociality of the village inhabitants. Drawing on recent anthropological work on time, human temporality is viewed as the product of symbolic processes, through which agents make evident, and act upon, the inherently temporal character of existence. In this sense the apprehension and significance of the past is implicated in a dynamic with present action and future orientations, and interpreted accordingly. However, a 'culturalist' perspective is avoided in the thesis by foregrounding the importance of interpreting all human activity as both historically situated, and implicated in wider political economic processes. In this respect, the thesis also pays attention to issues of political economy, and attempts a partial synthesis of different anthropological approaches: the phenomenological, the symbolic, and the materialist

Radiation Safety Aspects of Linac Operation with Bremsstrahlung Converters

This chapter provides a discussion of radiation safety aspects of operation of electron linear accelerators equipped with bremsstrahlung converters. Electron accelerators with 3, 6, 9 and 15 MeV electron beams are discussed. High-energy photon and photoneutron production during linac operation was analyzed using Monte Carlo methods. Radiation dose rates for different configurations of linacs were evaluated and compared with experimental results