Ultrasound-Guided Intravenous Access as a First-Line Approach by Nurses: A Quality Improvement Project

Background: Up to 9% of patients admitted to EDs (Emergency Departments) have difficult intravenous insertion access issues (DIVA). This creates delays in patient care that includes interruptions for physicians providing medical emergency care. Often the utilization of RNs to perform US (ultrasound) IV insertions is limited related to lack of training and supportive policies. Local Problem: The site for this project was an ED Level 1 Trauma Center associated with a large teaching hospital located in the southeastern U.S. Prior to the implementation of the process improvement project, there was no formal education of RNs in the use of US for difficult insertion IVs, resulting in patient care delays and physician interruptions for IV starts. The purpose of this project was to reduce patient care delays related to patients with difficult IV insertions with the aim to train RNs to perform ultrasound-guided IV insertions. Methods: The Model for Improvement was utilized as a guide for this project. Using the PDSA (plan, do, study, act), which included a review of the literature for best practice, the RN education and ultrasound protocol was developed. Pre- and post-implementation DIVA patients\u27 baseline door-to-IV start and door-to-blood collection times were measured. Interventions: US educational sessions were developed and taught to 15 RNs in the ED. Results: ED increased the number of US proficient RNs to 24. Physician IV starts decreased by 12%. There were no significant differences between pre and post-intervention time to IV (p=0.552) or time to blood draw (p=0.081). Conclusions: The project increased RN availability for US-guided access and reduced physician interruptions. Post-intervention door-to-IV and door-to-blood draw times were not significantly different, possibly relating to ED volume during the time of the project. The project site will continue the RN US education program

An assessment of the effectiveness of the Polanyi equilibrium theory at predicting adsorption isotherms

The Polanyi Equilibrium Theory proposes that a characteristic curve exist which can, after the application of certain abscissa scale factors, describe the adsorption of all compounds on a given carbon. A study was undertaken, using published data from several sources on a variety of compounds and carbons to challenge the most fundamental aspects of the Polanyi Adsorption Equilibrium Theory. Its effectiveness as a predictive model was tested by constructing characteristic curves and comparing the observed isotherm data to the Polanyi predictions. The results support the existence of the characteristic curve. However, in several instances, experimental data was required to accurately determine the required scale factors. Data from several compounds indicates that these scale factors can be estimated from a single data point. A comparison of predicted to observed scale factors indicates that polarizability is effective in providing only an approximation of the true abscissa scale factors. An additional adjustment for adsorbate density is required to correct for the theorized inefficient packing of the solids in the carbon pores. However, after these empirically determined scale factors are applied, an accurate depiction of the data results

Impacts of Bermudagrass on Northern Bobwhite Chicks: Mobility and Heat Exposure

Conservation programs to benefit northern bobwhites (Colinus virginianus) and other agriculturally-related wildlife species often target crop-field margins for management. The Bobwhite Quail Initiative in Georgia is a program where 3- to 18-m strips are disked and left fallow for 3-year cycles. However, several exotic grasses, such as bermudagrass (Cynodon dactylon), encroach in field margins, reducing their usefulness for avian species. We hypothesized that dense mats of bermudagrass would be a physical barrier to bobwhite chicks and also serve as a heat trap reducing habitat quality. We conducted two experiments to assess these factors. First, we used human-imprinted bobwhite chicks, 5 and 10 days of age, to assess mobility through vegetation with 3 levels (none, moderate, and high) of bermudagrass invasion. There was a significant impact of bermudagrass density on mobility of 5-day old chicks (P 1⁄4 0.002), but no effect on 10-day old chicks (P 1⁄4 0.38). Second, we placed temperature recorders at ground level in plots in field margins that had .75% cover of bermudagrass and those with .75% coverage of forbs. The mean temperature of bermudagrass plots was greater than in forb plots (P 1⁄4 0.03). The percentage of time above the 40 8C critical threshold temperature for bobwhites was greatest in bermudagrass plots (P 1⁄4 0.03) and ranged over 33–38% of daytime hours, but only 6-26% for forb plots. Our data suggests that bermudagrass degrades the quality of field margins and control of exotic invasive grasses is warranted to improve their efficacy

Savor the Cryosphere

This article provides concise documentation of the ongoing retreat of glaciers, along with the implications that the ice loss presents, as well as suggestions for geoscience educators to better convey this story to both students and citizens. We present the retreat of glaciers—the loss of ice—as emblematic of the recent, rapid contraction of the cryosphere. Satellites are useful for assessing the loss of ice across regions with the passage of time. Ground-based glaciology, particularly through the study of ice cores, can record the history of environmental conditions present during the existence of a glacier. Repeat photography vividly displays the rapid retreat of glaciers that is characteristic across the planet. This loss of ice has implications to rising sea level, greater susceptibility to dryness in places where people rely upon rivers delivering melt water resources, and to the destruction of natural environmental archives that were held within the ice. Warming of the atmosphere due to rising concentrations of greenhouse gases released by the combustion of fossil fuels is causing this retreat. We highlight multimedia productions that are useful for teaching this story effectively. As geoscience educators, we attempt to present the best scholarship as accurately and eloquently as we can, to address the core challenge of conveying the magnitude of anthropogenic impacts, while also encouraging optimistic determination on the part of students, coupled to an increasingly informed citizenry. We assert that understanding human perturbation of nature, then choosing to engage in thoughtful science-based decision-making, is a wise choice. This topic comprised “Savor the Cryosphere,” a Pardee Keynote Symposium at the 2015 Annual Meeting in Baltimore, Maryland, USA, for which the GSA recorded supporting interviews and a webinar