Identification of Perioperative Barriers to Enhanced Recovery After Surgery in Colorectal Surgical Populations

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based in tradition that hinder patient recovery. This project is designed to address the identification of barriers in the implementation of ERAS in colorectal populations at specific perioperative identified levels for provider and patient crucial to quality and improvement practices. The Clinical Nurse Leader (CNL) is optimally suited for identification of perioperative barriers for the implementation of ERAS as a clinician while focusing on complex nature of ERAS in the increasingly complex and diverse patient populations in multiple environments. Functioning in the role of systems analyst/risk anticipator, the CNL is able to review systems in place to improve quality of client care delivery while focusing on individual patient care to evaluate and anticipate risks to safety with the goal of prevention of medical error (AACN, 2007)

Dialogues that Dig Deeper: Surfacing the Multiple Faces of Homelessness in Grand Rapids, MI (Report Two)

This community dialogue was designed to identify current gaps in responses to homelessness in Grand Rapids as well as options for addressing those gaps. Given the feedback received, this report focuses on (1) mentorship programs similar to the aftercare program at Dégagé, (2) facilitated housing, and (3) ideas for fostering social connectedness. Through primary and secondary research as well as an analysis of our dialogue, our team was able to identify key areas of need in the fight for consistent, stable housing. Below you will find an outline of those ideas, more theoretical research on the subject, and data on homelessness/home-finding in general. The results will be shared with Dégagé, Seeds of Promise, nonprofit leaders, Grand Rapids businesses and openly published so any interested stakeholders can access the lessons learned

Harvest Incentives: A Tool for Managing Aquatic Invasive Species

Conclusion The success of any harvest incentive program to address aquatic invasive species will depend upon numerous biological, socioeconomic, and legal considerations. Programs that encourage harvest may be a successful management tool in targeting small, distinct populations; in high priority areas within a larger invasion; or they may play a supplementary role within larger control programs. Their use, however, will require careful review, planning, and monitoring to ensure success and that they do not unintentionally lead to further spread of invasive species, cause additional harm to native species, or waste valuable resources

Finding Nature in Your Neighborhood: A Field Mapping Protocol for Community Based Assessment of Greenspace Access

The Audubon Society of Portland and PSU Capstone students developed the Greenspace Access Point Field Mapping Protocol during the summer of 2013. The protocol was developed as a tool for a community-based approach to inventorying open space access points and to generate more accurate information on open space access in the Portland-Metro region

Air Pollution and Odor in Communities Near Industrial Swine Operations

BackgroundOdors can affect health and quality of life. Industrialized animal agriculture creates odorant compounds that are components of a mixture of agents that could trigger symptoms reported by neighbors of livestock operations.ObjectiveWe quantified swine odor episodes reported by neighbors and the relationships of these episodes with environmental measurements.MethodsBetween September 2003 and September 2005, 101 nonsmoking volunteers living within 1.5 mi of industrial swine operations in 16 neighborhoods in eastern North Carolina completed twice-daily odor diaries for approximately 2 weeks. Meteorological conditions, hydrogen sulfide, and particulate matter ≤ 10 μm in aerodynamic diameter (PM10) were monitored in each neighborhood. We used mixed models to partition odor variance within and between people and between neighborhoods, and to quantify relationships between environmental factors and odor.ResultsParticipants reported 1,655 episodes of swine odor. In nine neighborhoods, odor was reported on more than half of study-days. Odor ratings were related to temperature, PM10, and semivolatile PM10 in standard but not mixed models. In mixed models, odor increased 0.15 ± 0.05 units (mean ± SE) for a 1-ppb increase in H2S, and 0.45 ± 0.14 units for a 10-μg/m3 increase in PM10 at wind speeds > 6.75 miles per hour. The odds of reporting a change in daily activities due to odor increased 62% for each unit increase in average odor during the prior 12 hr (t-value = 7.17).ConclusionsThis study indicates that malodor from swine operations is commonly present in these communities and that the odors reported by neighbors are related to objective environmental measurements and interruption of activities of daily life

Air Pollution, Lung Function, and Physical Symptoms in Communities Near Concentrated Swine Feeding Operations

Concentrated animal feeding operations emit air pollutants that may affect health. We examined associations of reported hog odor and of monitored air pollutants with physical symptoms and lung function in people living within 1.5 miles of hog operations

Estimating Contact Exposure in Football Using the Head Impact Exposure Estimate

Over the past decade, there has been significant debate regarding the effect of cumulative subconcussive head impacts on short and long-term neurological impairment. This debate remains unresolved, because valid epidemiological estimates of athletes' total contact exposure are lacking. We present a measure to estimate the total hours of contact exposure in football over the majority of an athlete's lifespan. Through a structured oral interview, former football players provided information related to primary position played and participation in games and practice contacts during the pre-season, regular season, and post-season of each year of their high school, college, and professional football careers. Spring football for college was also included. We calculated contact exposure estimates for 64 former football players (n=32 college football only, n=32 professional and college football). The head impact exposure estimate (HIEE) discriminated between individuals who stopped after college football, and individuals who played professional football (p<0.001). The HIEE measure was independent of concussion history (p=0.82). Estimating total hours of contact exposure may allow for the detection of differences between individuals with variation in subconcussive impacts, regardless of concussion history. This measure is valuable for the surveillance of subconcussive impacts and their associated potential negative effects