Comparative Storage and Utilization Analysis of Insulin Across Inpatient Hospital Settings

Insulin is the primary medication used by health systems across the nation to provide glucose control to those patients who need it. As this medication is generally available in a multi-dose vial, proper administration techniques should be used to minimize waste and optimize the cost effectiveness of the drug. Even though dosing guidelines for hospital use of insulin exist each institution has the opportunity to choose their administration technique. In this paper I will to identify administration characteristics utilized by four different hospitals in the central Kentucky area, compare and contrast those techniques through data collection, and analyze the findings to determine the process that reduces the most waste and allows for the most cost effective use of the drug. This study focuses on insulin use processes at the following hospitals: Good Samaritan Hospital (Good Sam), the University of Kentucky Chandler Medical Center (UKCMC), Baptist Health-Richmond (BH), and the Lexington Veteran’s Affairs Hospital (VA). The purpose of the study is to gain an understanding of the use of insulin at Good Sam by collecting data over a two-week period and comparing that data to each of the other three hospitals. The data for these three hospitals was collected and studied throughout the completion of rotations at each institution. This comparison will allow for the identify of areas for improvement within Good Sam’s current insulin management process. Data collection measures included their insulin storage on the inpatient floors, insulin administration process, insulin purchasing process, and insulin waste process. Data collected at Good Sam was used to determine the amount of insulin waste (in milliliters) being collected each day over the two-week period. An average of that value was obtained and extrapolated to determine an approximate waste per six months. Using the current purchasing data for insulin, I determined the approximate cost of the insulin waste produced at Good Sam. Utilizing the knowledge of the insulin management process at Good Sam I was able to spend the next 18 weeks analyzing three other hospital’s insulin management process to determine ways to better utilize the insulin at Good Sam and to develop strategies to reduce insulin waste. This study serves as the basis for several recommendations to modify the insulin management process used at Good Sam. System wide nursing education on the proper technique to prepare insulin doses will be the foundation of these modifications. This education will include the preparation of the doses to occur at the Pyxis machines (automated dispensing cabinets) rather than the bedside. This minimizes the opportunity for distraction and increases the likelihood that vials will be replaced to their appropriate location to reduce waste. An additional recommendation includes storing vials of the of the insulin types that are used less frequently unopened in the fridge until needed. This will minimize the loss of product due to product expiration

Order for materials, 22 February 1870

https://egrove.olemiss.edu/aldrichdocs/1286/thumbnail.jp

Order for materials, 3 September 1871

https://egrove.olemiss.edu/aldrichdocs/1050/thumbnail.jp

Waterborne GPR survey for estimating bottom-sediment variability: A survey on the Po River, Turin, Italy

We conducted an integrated geophysical survey on a stretch of the river Po in order to check the GPR ability to discriminate the variability of riverbed sediments through an analysis of the bottom reflection amplitudes. We conducted continuous profiles with a 200-MHzGPR system and a handheld broadband EM sensor.Aconductivity meter and a TDR provided punctual measurements of water conductivity, permittivity, and temperature. The processing and interpretation of the GEM-2 and GPR data were enhanced by reciprocal results and by integration with the punctual measurements of the EM properties of the water. We used a processing flow that improved the radargram images and preserved the amplitude ratios among the different profiles and the frequency content at the bottom reflection signal.We derived the water attenuation coefficient both from the punctual measurements using the Maxwell formulas and from the interpretation of the GPR data, finding an optimal matching between the two values. The GPR measurements provided maps of the bathymetry and of the bottom reflection amplitude. The high reflectivity of the riverbed, derived from the GPR interpretation, agreed with the results of the direct sampling campaign that followed the geophysical survey. The variability of the bottom-reflection-amplitudes map, which was not confirmed by the direct sampling, could also have been caused by scattering phenomena due to the riverbed clasts which are dimensionally comparable to the wavelength of the radar pulse

Learner Requirements and Geospatial Literacy Challenges for Making Meaning with Google Earth

This research contributes an educational research perspective to teaching and learning with geospatial technologies. This work considers the literacy of a geospatial text that is readily accessible to students, but often assumed to be intuitive to read– dynamic scalable satellite imagery, which often serves as base maps for common navigation, GIS, and virtual globe applications. Within the context of a STEM project, Grades 5 and 6 students were observed and interviewed to identify knowledge and skills that were required to make meaning of Google Earth imagery. A qualitative methodological approach incorporating a thinkaloud data collection protocol was followed to stay true to the breadth, depth and nuances of the student voice and experience. When engaged with Google Earth, the students were observed to employ a range of image interpretation skills, demonstrated various expertise in navigation, and also drew upon their knowledge of the technology. Challenges to understanding the imagery included dominant alignment effect, dimensional translation, and interpreting the nadir view. Students who had an understanding of the underlying technology of the application were better able to overcome these challenges. These results suggest that ensuring students have knowledge about the technology itself, and basic literacy of satellite imagery, is valuable in order to make meaning of the data, critical at this age when students are developing their mental constructs of the world with such geospatial data

Human Cytomegalovirus pTRS1 and pIRS1 Antagonize Protein Kinase R To Facilitate Virus Replication

ABSTRACT Human cytomegalovirus (HCMV) counteracts host defenses that otherwise act to limit viral protein synthesis. One such defense is the antiviral kinase protein kinase R (PKR), which inactivates the eukaryotic initiation factor 2 (eIF2) translation initiation factor upon binding to viral double-stranded RNAs. Previously, the viral TRS1 and IRS1 proteins were found to antagonize the antiviral kinase PKR outside the context of HCMV infection, and the expression of either pTRS1 or pIRS1 was shown to be necessary for HCMV replication. In this study, we found that expression of either pTRS1 or pIRS1 is necessary to prevent PKR activation during HCMV infection and that antagonism of PKR is critical for efficient viral replication. Consistent with a previous study, we observed decreased overall levels of protein synthesis, reduced viral protein expression, and diminished virus replication in the absence of both pTRS1 and pIRS1. In addition, both PKR and eIF2α were phosphorylated during infection when pTRS1 and pIRS1 were absent. We also found that expression of pTRS1 was both necessary and sufficient to prevent stress granule formation in response to eIF2α phosphorylation. Depletion of PKR prevented eIF2α phosphorylation, rescued HCMV replication and protein synthesis, and reversed the accumulation of stress granules in infected cells. Infection with an HCMV mutant lacking the pTRS1 PKR binding domain resulted in PKR activation, suggesting that pTRS1 inhibits PKR through a direct interaction. Together our results show that antagonism of PKR by HCMV pTRS1 and pIRS1 is critical for viral protein expression and efficient HCMV replication. IMPORTANCE To successfully replicate, viruses must counteract host defenses that limit viral protein synthesis. We have identified inhibition of the antiviral kinase PKR by the viral proteins TRS1 and IRS1 and shown that this is a critical step in HCMV replication. Our results suggest that inhibiting pTRS1 and pIRS1 function or restoring PKR activity during infection may be a successful strategy to limit HCMV disease

Mechanism of Protein Kinase R Inhibition by Human Cytomegalovirus pTRS1

ABSTRACT Double-stranded RNAs (dsRNA) produced during human cytomegalovirus (HCMV) infection activate the antiviral kinase protein kinase R (PKR), which potently inhibits virus replication. The HCMV pTRS1 and pIRS1 proteins antagonize PKR to promote HCMV protein synthesis and replication; however, the mechanism by which pTRS1 inhibits PKR is unclear. PKR activation occurs in a three-step cascade. First, binding to dsRNA triggers PKR homodimerizaton. PKR dimers then autophosphorylate, leading to a conformational shift that exposes the binding site for the PKR substrate eIF2α. Consistent with previous in vitro studies, we found that pTRS1 bound and inhibited PKR. pTRS1 binding to PKR was not mediated by an RNA intermediate, and mutations in the pTRS1 RNA binding domain did not affect PKR binding or inhibition. Rather, mutations that disrupted the pTRS1 interaction with PKR ablated the ability of pTRS1 to antagonize PKR activation by dsRNA. pTRS1 did not block PKR dimerization and could bind and inhibit a constitutively dimerized PKR kinase domain. In addition, pTRS1 binding to PKR inhibited PKR kinase activity. Single amino acid point mutations in the conserved eIF2α binding domain of PKR disrupted pTRS1 binding and rendered PKR resistant to inhibition by pTRS1. Consistent with a critical role for the conserved eIF2α contact site in PKR binding, pTRS1 bound an additional eIF2α kinase, heme-regulated inhibitor (HRI), and inhibited eIF2α phosphorylation in response to an HRI agonist. Together our data suggest that pTRS1 inhibits PKR by binding to conserved amino acids in the PKR eIF2α binding site and blocking PKR kinase activity. IMPORTANCE The antiviral kinase PKR plays a critical role in controlling HCMV replication. This study furthered our understanding of how HCMV evades inhibition by PKR and identified new strategies for how PKR activity might be restored during infection to limit HCMV disease

Mutations in the E2 glycoprotein and the 3\u27 untranslated region enhance chikungunya virus virulence in mice

Chikungunya virus (CHIKV) is a mosquito-transmitted alphavirus that causes debilitating musculoskeletal pain and inflammation and can persist for months to years after acute infection. Although studies of humans and experimentally infected animals suggest that CHIKV infection persists in musculoskeletal tissues, the mechanisms for this remain poorly understood. To evaluate this further, we isolated CHIKV from the serum of persistently infected Rag1 -/- mice at day 28. When inoculated into naive wild-type (WT) mice, this persistently circulating CHIKV strain displayed a capacity for earlier dissemination and greater pathogenicity than the parental virus. Sequence analysis revealed a nonsynonymous mutation in the E2 glycoprotein (E2 K200R) and a deletion within the 3' untranslated region (3'-UTR). The introduction of these changes into the parental virus conferred enhanced virulence in mice, although primary tropism for musculoskeletal tissues was maintained. The E2 K200R mutation was largely responsible for enhanced viral dissemination and pathogenicity, although these effects were augmented by the 3'- UTR deletion. Finally, studies with Irf3/Irf7 -/- and Ifnar1 -/- mice suggest that the E2 K200R mutation enhances viral dissemination from the site of inoculation independently of interferon regulatory factor 3 (IRF3)-, IRF7-, and IFNAR1-mediated responses. As our findings reveal viral determinants of CHIKV dissemination and pathogenicity, their further study should help to elucidate host-virus interactions that determine acute and chronic CHIKV infection

Coupling Manure Injection with Cover Crops to Enhance Nutrient Cycling

Large-scale hog (Sus scroja) production is a major agricultural enterprise in the Midwest. Large numbers of confined hogs produce about 50 million tons per year of swine manure in Iowa alone. Rapid expansion of concentrated animal feeding operations (CAFOs) has resulted in increased concentrations of manure nutrients in surface waters which contribute about 15% of the total nitrate load in the Mississippi River Basin. Producers are being encouraged to develop manure management practices that fulfill crop production requirements, while minimizing the potential for environmental pollution. The most commonly used manure management practice in the Midwest involves fall application to land where corn (Zea mays L.) will be grown in the subsequent growing season. Fall planted annual cover crops can capture manure nutrients and immobilize them in plant biomass, subsequently reducing the potential for nutrient loss through run-off or leaching. Decomposition of cover crop residue the following spring may help synchronize manure N availability and corn N uptake, improving nutrient-use efficiency within the crop rotation