Bridging the Gap: Educating Medical-Surgical Unit Nurses in a Large Hospital Organization on Sepsis Bundle Elements

Problem: Sepsis is a life-threatening response to infection that remains one of the leading causes of death worldwide. Based off results obtained from a pre-education survey of nurses on a medical-surgical unit in a large hospital organization, there is an opportunity to increase knowledge and confidence level regarding sepsis and care of septic patients so that nurses are prepared to detect sepsis early and intervention can begin. Context: The project is being conducted in a medical-surgical unit at a large hospital organization in Northern California. The data from the survey includes 17 nurses on the unit who completed the pre-education survey on February 15, 2023, by Dr. Theresa Mostasisa. Interventions: Nurses on the unit will be educated on sepsis through a handout presented at the monthly staff meeting. This handout will also be distributed on the unit in order to increase nurse awareness regarding sepsis along with the facility’s protocol surrounding the timed sepsis bundle requirements. Measures: The anonymous pre-education survey was distributed to nurses on the medical-surgical unit to gain an understanding of the nurses’ knowledge and confidence in recognizing and managing patients diagnosed with sepsis. The survey includes five quantitative data-based questions to assess individual knowledge and confidence level and one qualitative data-based question which attempts to recognize the respondent’s familiarity with the facility’s sepsis bundle requirements. After education has taken place, the same survey questions will be given as a post-education survey in order to determine if the intervention was successful. Results: Due to time constraints, the post-education survey results were not obtained. Based off evidence-based practice, this intervention will be successful. A study conducted by Chua et al. (2022) found that education and sepsis training results in higher knowledge and confidence scores when surveyed. A study conducted by Choy et al. (2022) found educational programs to be effective and provide a positive effect on knowledge outcomes which leads to improvements in patient outcomes. A study by Yousefi et al. (2012) concluded that and educational workshop improved knowledge, attitude and practice of nurses in the study. Conclusions: Nurses are placed in a unique position at the bedside to respond quickly and efficiently if a patient is showing warning signs for developing sepsis. Through educational initiatives, the hospital can support nurses by ensuring they have a high knowledge and confidence level in recognizing and caring for patients with sepsis to ensure high-quality, safe care is provided

A case of pulmonary hemorrhage and renal failure

Background: Alveolar hemorrhage can be seen in many vasculitic disorders. However, granulomatosis polyangiitis (formerly Wegener’s granulomatosis) uncommonly presents with life threatening alveolar hemorrhage and has only been discussed in a few case reports [1]. Case Presentation: A 53 year old Caucasian male presented with hemoptysis and profound anemia. Two weeks prior, he had presented with abdominal pain with normal renal function and numerous pulmonary nodules. During the current admission, the patient was hypoxic with acute renal failure requiring hemodialysis. Urine sediment demonstrated dysmorphic red blood cells. A bronchoscopy revealed diffuse alveolar hemorrhage. The diagnosis of pulmonary-renal syndrome was made and therapeutic plasma exchange was initiated. Laboratory studies were significant for a c-ANCA titer positive at 1:640 FIU and anti-proteinase (PR)-3 antibody titer positive with 78.3 U/ml. Renal biopsy demonstrated necrotizing crescentic glomerulonephritis. A diagnosis of granulomatosis vasculitis was determined. Conclusion: Alveolar hemorrhage is rare to be the presenting symptom of granulomatosis vasculitis where the common presenting features are recurrent sinusitis, epistaxis, chronic otitis media or rhinitis. Physicians should consider granulomatosis vasculitis in the differential diagnosis of pulmonary-renal syndrome presenting with hemoptysis

Explaining the Rise in Educational Gradients in Mortality

The long-standing inverse relationship between education and mortality strengthened substantially later in the 20th century. This paper examines the reasons for this increase. We show that behavioral risk factors are not of primary importance. Smoking has declined more for the better educated, but not enough to explain the trend. Obesity has risen at similar rates across education groups, and control of blood pressure and cholesterol has increased fairly uniformly as well. Rather, our results show that the mortality returns to risk factors, and conditional on risk factors, the return to education, have grown over time.

Health and Economic Benefits of Improved Injury Prevention and Trauma Care Worldwide

Objectives: Injury is a significant source of morbidity and mortality worldwide, and often disproportionately affects younger, more productive members of society. While many have made the case for improved injury prevention and trauma care, health system development in low- and middle-income countries is often limited by resources. This study aims to determine the economic benefit of improved injury prevention and trauma care in low- and middle-income countries. Methods: This study uses existing data on injury mortality worldwide from the 2010 Global Burden of Disease Study to estimate the number of lives that could be saved if injury mortality rates in low- and middle-income countries could be reduced to rates in high-income countries. Using economic modeling – through the human capital approach and the value of a statistical life approach – the study then demonstrates the associated economic benefit of these lives saved. Results: 88 percent of injury-related deaths occur in low- and middle-income countries. If injury mortality rates in low- and middle-income countries were reduced to rates in high-income countries, 2,117,500 lives could be saved per year. This would result in between 49 million and 52 million disability adjusted life years averted per year, with discounting and age weighting. Using the human capital approach, the associated economic benefit of reducing mortality rates ranges from $245 to$261 billion with discounting and age weighting. Using the value of a statistical life approach, the benefit is between 758 and 786 billion dollars per year. Conclusions: Reducing injury mortality in low- and middle-income countries could save over 2 million lives per year and provide significant economic benefit globally. Further investments in trauma care and injury prevention are needed

Exploring the relationship between productive vocabulary knowledge and second language oral ability

The current study investigated the extent to which L2 learners’ productive vocabulary knowledge could predict multiple dimensions of spontaneous speech production. A total of 39 EFL participants with varying L2 proficiency levels first completed a productive vocabulary knowledge task (Lex30). Their spontaneous speech, elicited via a series of picture description task, was then assessed for comprehensibility (i.e., ease of understanding), accentedness (i.e., linguistic nativelikeness), and fluency (i.e., speech rate). The findings showed that the productive vocabulary scores significantly correlated with L2 fluency, but not with comprehensibility or accentedness. Such results might indicate that more proficient L2 learners, as indicated by their productive vocabulary scores, might be able to speak spontaneously without too many pauses and repetitions, and at a faster tempo. Finally, future research directions will be discussed with a focus on the relationships between vocabulary knowledge and speaking

Diamond (111) surface reconstruction and epitaxial graphene interface

The evolution of the diamond (111) surface as it undergoes reconstruction and subsequent graphene formation is investigated with angle-resolved photoemission spectroscopy, low energy electron diffraction, and complementary density functional theory calculations. The process is examined starting at the C(111)-(2x1) surface reconstruction that occurs following detachment of the surface adatoms at 920 {\deg}C, and continues through to the liberation of the reconstructed surface atoms into a free-standing monolayer of epitaxial graphene at temperatures above 1000 {\deg}C. Our results show that the C(111)-(2x1) surface is metallic as it has electronic states that intersect the Fermi-level. This is in strong agreement with a symmetrically {\pi}-bonded chain model and should contribute to resolving the controversies that exist in the literature surrounding the electronic nature of this surface. The graphene formed at higher temperatures exists above a newly formed C(111)-(2\times1) surface and appears to have little substrate interaction as the Dirac-point is observed at the Fermi-level. Finally, we demonstrate that it is possible to hydrogen terminate the underlying diamond surface by means of plasma processing without removing the graphene layer, forming a graphene-semiconductor interface. This could have particular relevance for doping the graphene formed on the diamond (111)surface via tuneable substrate interactions as a result of changing the terminating species at the diamond-graphene interface by plasma processing.Comment: 10 pages, 4 figure

Operationalising and measuring language dominance

The paper offers a new way to measure language ability in bilinguals, based on measures of lexical richness. The validity of proposed approach is tested in a variety of ways

Assessing L2 vocabulary depth with word associates format tests: issues, findings, and suggestions

Word Associates Format (WAF) tests are often used to measure second language learners’ vocabulary depth with a focus on their network knowledge. Yet, there were often many variations in the specific forms of the tests and the ways they were used, which tended to have an impact on learners’ response behaviors and, more importantly, the psychometric properties of the tests. This paper reviews the general practices, key issues, and research findings that pertain to WAF tests in four major areas, including the design features of WAF tests, conditions for test administration, scoring methods, and test-taker characteristics. In each area, a set of variables is identified and described with relevant research findings also presented and discussed. Around eight topics, the General Discussion section provides some suggestions and directions for the development of WAF tests and the use of them as research tools in the future. This paper is hoped to help researchers become better aware that the results generated by a WAF test may vary depending on what specific design the test has, how it is administered and scored, and who the learners are, and consequently, make better decisions in their research that involves a WAF test