The thermally-unstable warm neutral medium: key for modeling the interstellar medium

We present 21-cm absorption measurements towards 12 radio continuum sources with previously identified thermally-unstable warm neutral medium (WNM). These observations were obtained with the Expanded Very Large Array (EVLA) and were complemented with the HI emission spectra obtained with the Arecibo Observatory. Out of 12 sources, HI absorption was detected along 5 lines of sight (seven new absorption features in total), resulting in a detection rate of ~42%. While our observations are sensitive to the WNM with a spin temperature T_s<3000 K, we detected only two wide absorption lines with T_s=400-900 K. These temperatures lie above the range allowed for the cold neutral medium (CNM) by the thermal equilbrium models and signify the thermally unstable WNM. Several absorption features have an optical depth of only a few x10^{-3}. While this is close or lower than what is theoretically expected for the CNM, we show that these weak lines are important for constraining the fraction of the thermally unstable WNM. Our observations demonstrate that, for the first time, high bandpass stability can be achieved with the VLA, allowing detection of absorption lines with a peak optical depth of ~10^{-3}.Comment: 10 pages. Accepted by Ap

Dry Needling for Spine Related Disorders: a Scoping Review

Introduction/Background: The depth and breadth of research on dry needling (DN) has not been evaluated specifically for symptomatic spine related disorders (SRD) from myofascial trigger points (TrP), disc, nerve and articular structures not due to serious pathologies. Current literature appears to support DN for treatment of TrP. Goals of this review include identifying research published on DN treatment for SRD, sites of treatment and outcomes studied. Methods: A scoping review was conducted following Levac et al.’s five part methodological framework to determine the current state of the literature regarding DN for patients with SRD. Results: Initial and secondary search strategies yielded 55 studies in the cervical (C) region (71.43%) and 22 in the thoracolumbar-pelvic (TLP) region (28.57%). Most were randomized controlled trials (60% in C, 45.45% in TLP) and clinical trials (18.18% in C, 22.78% in TLP). The most commonly treated condition was TrP for both the C and TLP regions. In the C region, DN was provided to 23 different muscles, with the trapezius as treatment site in 41.88% of studies. DN was applied to 31 different structures in the TLP region. In the C region, there was one treatment session in 23 studies (41.82%) and 2–6 treatments in 25 (45.45%%). For the TLP region, one DN treatment was provided in 8 of the 22 total studies (36.36%) and 2–6 in 9 (40.9%). The majority of experimental designs had DN as the sole intervention. For both C and TLP regions, visual analogue scale, pressure pain threshold and range of motion were the most common outcomes. Conclusion: For SRD, DN was primarily applied to myofascial structures for pain or TrP diagnoses. Many outcomes were improved regardless of diagnosis or treatment parameters. Most studies applied just one treatment which may not reflect common clinical practice. Further research is warranted to determine optimal treatment duration and frequency. Most studies looked at DN as the sole intervention. It is unclear whether DN alone or in addition to other treatment procedures would provide superior outcomes. Functional outcome tools best suited to tracking the outcomes of DN for SRD should be explored.https://doi.org/10.1186/s12998-020-00310-

THE WILD THAT REMAINS: A ONCE IN A GENERATION FOREST PLAN REIGNITES THE WILDERNESS DEBATE IN MONTANA’S GALLATIN RANGE

The movement to preserve Montana’s Gallatin Mountains, which stretch north from Yellowstone National Park, has been ongoing since the passage of the Wilderness Act in 1964. Largely undeveloped, the range’s sinuous, rocky crest, fertile meadows and thick lodgepole forests are vital to one of the earth’s last intact temperate ecosystems. The landscape provides refuge to rare populations of grizzly bears, elk, bighorn sheep, wolves and wolverines. Yet, the Gallatins remain the last major mountain range bordering the nation’s first and most iconic national park without congressionally designated wilderness. The closest the Gallatins came to being protected as wilderness was in the fall of 1988, when Montana’s former representative Pat Williams successfully steered legislation through Congress. However, President Regan refused to sign the bill. Now, over 30 years later, as the Custer Gallatin National Forest updates its forest plan for the first time in a generation, a group of mountain bikers, hunters, mountain guides, horsemen, dude ranchers and wilderness advocates think they have the support and momentum to finally preserve the range as wilderness. For the first time ever, the Forest Service is poised to recommend that the core of the range be managed as wilderness, and a new legislative campaign is about to begin. This story follows community members, who are both for and against a Gallatin Wilderness proposal, as they share their values and visions for the future of the landscape. Along the way, the story examines the history of the wilderness movement in the Gallatins, collaborative planning efforts on the forest and the complex politics of passing a wilderness bill in Congress.https://scholarworks.umt.edu/grad_portfolios/1299/thumbnail.jp

Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit

Background: Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. Local Problem: Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. Methods: Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. Interventions: A new self-proning nursing protocol was implemented outside the intensive care unit. Results: Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. Conclusions: Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic

Implementation and Assessment of a Proning Protocol for Nonintubated Patients With COVID-19

Introduction: The COVID-19 pandemic has caused over 1,250,000 deaths worldwide. With limited therapeutic options, proning nonintubated patients emerged as a safe and affordable intervention to manage hypoxemia. Methods: A proning protocol to identify and prone eligible patients was implemented. Patients were encouraged to self-prone for 2-3 hours, 3 times daily. Investigators created educational materials for nurses and patients and developed a COVID-19-specific proning order within the electronic health record (EHR). Investigators completed an 800-person retrospective chart review to study the implementation of this protocol. Results: From March 22, 2020, to June 5, 2020, 586 patients were admitted to the COVID-19 floor. Of these patients, 42.8% were eligible for proning. Common contraindications were lack of hypoxia, altered mental status, and fall risk. The proning protocol led to a significant improvement in provider awareness of patients appropriate for proning, increasing from 12% to 83%, as measured by placement of a proning order into the EHR. There was a significant improvement in all appropriate patients documented as proned, increasing from 18% to 45% of eligible patients. Conclusions: The creation of an effective hospital-wide proning protocol to address the exigencies of the COVID-19 pandemic is possible and may be accomplished in a short period of time