An Interprofessional Collaboration to Increase Total Enteral Nutrition in Critically Ill Patients on Vasopressor Agents in CVICU

Background: Delayed enteral nutrition (EN) in critically ill patients increases the risk of complications and poor outcomes. The 2016 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and Society of Critical Care Medicine (S.C.C.M.) evidence-based guideline recommends initiating EN within 24-48 hours of Intensive Care Unit (ICU) admission once resuscitation and hemodynamically stability have been achieved. The evidence-based guideline notes that critically ill patients on low-dose vasopressors can be started on EN with close monitoring. Purpose: This interprofessional project aims to increase the amount of EN delivered to all qualifying Cardiovascular Intensive Care Unit (CVICU) patients who are at risk for poor nutrition through the use of staff education, improved guideline compliance, dietary consultations, and chart audits. Methods: A retrospective and prospective chart audit and pre-and-post-nursing survey to determine overall nutritional intake via EN in CVICU patients with vasopressor agents. The CVICU nurses will complete a pre-test via Redcaps, receive digital education (voiceover PowerPoint), and then a post-test via Redcap’s survey software. Retrospective institutional data (chart audit) will be collected to compare the total volume of EN received in the eligible population within 48 hours of vasopressor initiation at baseline (pre-education) compared to after-education intervention. The chart audit will also review the coordination of nutrition care between the critical care team, as evidenced by increasing nutrition consult orders within 24 hours of vasopressor initiation. Results: There was a significant improvement in confidence level using the University of Kentucky Healthcare (UKHC) EN feeding guideline (p-value \u3c .001). Most respondents 3 considered their EN knowledge average/above average in pre and post-test (86.8% and 92%). Although 86.8% of participants had considered their EN knowledge average/above average in the pretest, respondents reported a knowledge deficit (less than 25% correct) in the pretest about the timing of EN, differentiating between high-risk vasopressor dose when on multiple pressors, tube feed formula, signs and symptoms of feeding intolerance, and clinical evidence required to initiate EN. Only 22% (n=9) of patients in the pre-intervention chart review and 37.5% (n=15) of patients in the post-intervention chart review were started on EN within less than 48 hours of vasopressors being ordered. Therefore, initiating EN within 48 hours of vasopressors being ordered (p-value 0.125) or increasing the number of nutrition consult orders (p-value 0.325) and nutrition evaluation (p-value 0.381) was not statistically significant. Conclusion: There is still a gap in initiating EN therapy within 48 hours of vasopressors. However, more education and a larger sample size can better understate guideline compliance. This study demonstrated the positive impact of a multifaceted educational approach on nursing knowledge and attitudes. Despite the established guideline, it highlighted some challenges and gaps associated with EN in the ICU

‘MakingThings Happen’ in Cross-sector Partnerships: A Multiple Case Study

Cross-sector collaborative partnerships aim to bring resources and knowledge from their particular sectors to provide innovative solutions in response to current social, economic and environmental problems, and for developing policies and processes for emergent issues. However, cross-sector partnerships involving public (i.e., institutions of higher education), private, and nonprofit organizations are complex and dynamic systems that are extremely difficult to manage once they have been established. Organizations spanning different sectors not only have dissimilar operating models, working cultures, values, and leadership styles, but are driven by different motives in joining the partnership thereby making the act of collaborating very challenging. When performing well, cross-sector collaborative partnerships have transformative outcomes due to the collaborative advantage possible with the participants’ knowledge and resources. However, these partnerships are rarely successful due to what is termed “collaborative inertia,” which prevents progress towards goals. This study examined the mechanisms that “make things happen” in two cross-sector collaborative partnerships using a qualitative, multiple case study approach. The study analyzed numerous data sources, providing 24-months of longitudinal data regarding the creation and operations of the partnerships. Through this approach, this research was able to operationalize the concept of collaborative inertia and made substantial contributions to the concept of “making things happen” in the theory of collaborative advantage. In particular, deeper understanding has been provided in understanding the importance of partnership structure, repetitive communication processes, regularity in usage of collaborative spaces, balance in informal team roles, and collective actions that were key mechanisms that “made things happen” in the cross-sector collaborative partnerships studied

Deconstructing the ethos of concrete in Mumbai

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Architecture; and, (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2008.Includes bibliographical references (p. [153]-155).What can a building material tell us about a city? As the most widely used structural building material in the world, reinforced cement concrete shapes the urban form of several of our largest megacities Sao Paulo, Cairo, Karachi and Mumbai, to name a few. The predominant building form concrete takes in these cities, is of the concrete frame. This dissertation traces the emergence of the concrete frame as the preferred form taken by reinforced concrete in widespread urban applications, over a myriad of sculptural possibilities that the material offers. Proceeding from the assertion that the manifestation of form reveals to us the condition of its production, in other words the built environment of the city can tell us about the society that inhabits it - I investigate what I call the ethos of concrete in Mumbai as a way of understanding the state of some aspects of the city's society. It must be emphasized that I look specifically at ethos of production rather than reception of concrete framed buildings in the city of Mumbai. The findings of this thesis are both its method of investigation and its discoveries. The frame is seen as the form concrete takes in Mumbai; hence for the scope of this thesis, the frame is concrete in Mumbai. Using the concrete frame as a heuristic device to investigate the production of urban form in the city, the thesis constructs a narrative of the physical formation of buildings that make the urban form of Mumbai. The frame is investigated at two scales, the terrain of the city, and level of the singular building. The ethos of concrete here is its spatial ethos and its productive ethos, each of which are seen at the scale of the city and the building.(cont.) The spatial ethos at the building level tell us about the evolution of the space between individual buildings and the genesis of gatedness in concrete apartment buildings in India, as well as well the development of bye laws which govern the form buildings can take in the city. The spatial ethos at the scale of the city tells us about the relation between land subdivision and the spread of the frame on older patterns of land holdings in the city. We find that the Concrete frame buildings occur in areas that have previously had larger plots, or on reclaimed land, while dense areas in the central part of the island city with small individual land holdings do not have many concrete buildings. The ethos of production at the scale of the city characterizes it as a "topological field" utilized for the serial production of the concrete frame as a lucrative commercial entity. This field of the city's plan on which the extrusion of concrete buildings takes place is seen the basis of the "chaotic" appearance of the city. And the productive ethos at the scale of buildings, seen as the generation of aesthetic design, shows us how the planimetric basis of the city is overcome by its buildings to invent new visual orders. Finally the productive ethos at the scale of the building is seen as the work of architects, developers and labourers involved in the construction of the concrete buildings in the city. While the vast availability of informal labour perpetuates the use of concrete at the level of the structure of the building - I have found that a hybrid practice of professional architectural design and informal artisanal labour enables the reinvention of the generic concrete frame in the city - hence allowing it to periodically reappear in new incarnations.(cont.) In conclusion the paradox of the material of concrete is that it enables both perpetuation and reinvention, Its plasticity enabling newer facades to be applied to the same underlying frame, and its labour conditions facilitating upward mobility for the middle classes while reinforcing its own entrenchment at the bottom of the productive order.by Priyanka Shah.M.C.P.S.M

Of roots and rootlessness: music, partition and Ghatak

At a time when the ‘commercial’ Bengali film directors were busy caricaturing the language and the mannerisms of the East-Bengal refugees, specifically in Calcutta, using them as nothing but mere butts of ridicule, Ritwik Ghatak’s films portrayed these ‘refugees’, who formed the lower middle class of the society, as essentially torn between a nostalgia for an utopian motherland and the traumatic present of the post-partition world of an apocalyptic stupor. Ghatak himself was a victim of the Partition of India in 1947. He had to leave his homeland for a life in Calcutta where for the rest of his life he could not rip off the label of being a ‘refugee’, which the natives of the ‘West’ Bengal had labeled upon the homeless East Bengal masses. The melancholic longing for the estranged homeland forms the basis of most of Ghatak’s films, especially the trilogy: Meghe Dhaka Tara (1960), Komol Gondhar (1960) and Subarnarekha (1961). Ghatak’s running obsession with the post-partition trauma acts as one of the predominant themes in the plots of his films. To bring out the tragedy of the situation more vividly, he deploys music and melodrama as essential tropes. Ghatak brilliantly juxtaposes different genres of music , from Indian Classical Music and Rabindra Sangeet to Folk songs, to carve out the trauma of a soul striving for recognition in a new land while, at the same time, trying hard to cope with the loss of its ‘motherland’. This article will show how Ghatak, in Komol Gandhar, uses music and songs to portray the dilemma that goes on in the mind of his protagonists and other important characters estranged from their motherland, which could have otherwise become very difficult to portray using the traditional methods of art-film making. I would also attempt to show how the different genres of music not only contribute to the portrayal of the cultural differences of ‘East’ and ‘West’ Bengal but also enforce and validate the diasporic identities of the refugees while in the process paradoxically point out the unity and oneness of both the ‘countries’ as well. It would also elaborate on Ghatak’s own complex notion regarding the Nation-State which reiterates itself in all his films. In discussing about Komol Gondhar, the paper would also contain an elaboration on the IPTA (Indian People’s Theatre Association) around which the plot of the film revolves

Magnitude of thyroid dysfunction among antenatal women attending tertiary care centre

Background: Thyroid disorders constitute one of the most common endocrine disorders in pregnancy. However, there is no universal guidelines to screen every Pregnant Woman for Thyroid dysfunction in India. This study was conducted to evaluate the magnitude of thyroid dysfunction among ante natal mothers in a tertiary care centre.Methods: This was a cross sectional observational study conducted on ante natal mothers for a period of 6 months. All consecutive ante natal mothers in their first trimester were included in this study. Exclusion criteria was pre-gestational thyroid dysfunction, hypertension and diabetes mellitus. After obstetric examination and investigation, thyroid function test (Free T4 and TSH) was done in all patients.Results: Mean age of the patients enrolled was 26.2±3.54 years. Mean gestational age at which they underwent screening was 9±2 weeks. The mean BMI of the study patients was 21.7±4. The prevalence of hypothyroidism in antenatal mothers was 14.5%. 5 patients (5.5%) had hyperthyroidism. The calculated mean TSH value was 4.26 mIU/L.Conclusions: Universal screening for thyroid dysfunction during pregnancy should be made mandatory in India due to high prevalence, in order to prevent maternal and foetal complications

Intelligent Controller Based on Artificial Neural Network and INC Based MPPT for Grid Integrated Solar PV System

Solar photovoltaic (PV) systems have become an integral part of today's advanced energy infrastructure due to its low kinetic energy, its abundance availability, and its freedom from human interference. Solar PV systems have the potential to greatly reduce our reliance on fossil fuels, but their intermittent nature means they cannot provide a constant source of electricity. The system's security should be well thought out, and it should be able to withstand a lot of abuse. The current energy system faces a significant difficulty in ensuring continuous supply. In this study, a three-phase, two-stage photovoltaic system that is managed by artificial neural networks (ANN). A DC-DC boost converter with maximum power point tracking (MPPT) based on the incremental conductance (INC) method is incorporated in the first stage. In the next step, an ANN-based controller optimizes the performance of a three-phase switching PWM inverter that is connected to the grid by controlling currents along the d-q axis. Comprehensive simulations were carried out using MATLAB or Simulink to evaluate the system's performance under various illumination and temperature conditions. Results show that the suggested approach outperforms the baseline in a number of areas. Better dynamic reactions, accurate tracking of reference currents within permissible bounds, and quick settling periods after startup are all displayed by it. These findings show that our method has the potential to greatly improve the efficiency and dependability of solar PV systems. The results of this study have implications for renewable energy in general and present a viable path toward enhancing the resilience and sustainability of energy infrastructure

Contrast-induced acute kidney injury following coronary angiography in patients with end-stage liver disease

Background: Contrast-induced acute kidney injury (CIAKI) following coronary angiography is frequently observed in the general population. End-stage liver disease (ESLD) patients are at a particularly increased risk for development of CIAKI following coronary angiography due to preexisting renal hypoperfusion. Methods: We performed a retrospective study of 544 consecutive cardiac catheterizations in ESLD patients from December 2003 to May 2013 to calculate the incidence of CIAKI post-coronary angiography and to identify risk factors for CIAKI. CIAKI was defined as a serum creatinine increase of either \u3e/= 25% or \u3e/= 0.5 mg/dL from baseline within 72 hours. Multivariable and Cox regression analysis was performed for development of CIAKI and all-cause mortality, respectively. Results: Overall, 179 cases of coronary angiography were included in the final analysis. CIAKI occurred in 23% of patients. All-cause mortality was 52% in the CIAKI group and 37% in the non-CIAKI group, with a mean follow-up of 2.2 +/- 3.8 years. Multivariable analysis identified intensive care unit admission (OR 2.72, CI 1.05-7.01, p \u3c 0.05) and baseline estimated glomerular filtration rate (OR 1.02, CI 1.002-1.035, p \u3c 0.05) as independent predictors of CIAKI. Cox regression analysis identified pre-angiography beta-blocker use (HR 2.13, CI 1.04-4.38, p \u3c 0.05), international normalized ratio (HR 1.37, CI 1.05-1.78, p \u3c 0.05) and Mehran risk score (HR 1.13, CI 1.02-1.25, p \u3c 0.05) as independent predictors of all-cause mortality. Conclusions: CIAKI in ESLD patients undergoing coronary angiography occurs at a moderately elevated rate when compared to the general population

Critical Analysis Of Transgender Persons (Protection Of Rights) Act, 2019

Through this study the researcher aims to do the critical analysis on the laws presently available for the LGBT Community. Are they mitigating the need and requirements of the LGBT Community and the freedom that they shall get at home in their personal life

Critical Evaluation Of Socio-Legal Enactments Related To Woman & Woman Empowerment

The government shall provide free education to females and especially all those who are in minorities who can’t avail the education easily or can’t afford it even if they are willing to be educated, to enhance the economy of the country, girls should be educated compulsorily, and it too provided free of cost, who actually require. The woman can become stronger if they are aware of the rights available to them in Indian Constitution and other Laws if she is educated, and also they can protest for their rights and secure themselves from discrimination in various places

Developing ophthalmology in Cambodia

Over 180,000 Cambodian people are blind and a further 10,000 suffer avoidable blindness each year. Ninety percent of this blindness is avoidable, 79% is curable and 11% is preventable. Three-quarters of this blindness is due to cataracts and the remainder is due to uncorrected vision, glaucoma, corneal scarring and pterygium. The Khmer Sight Foundation (KSF) is a charity reincarnated by Professor Sunil Shah and Sean Ngu. Its mission is to deliver a sustainable eye care model for the country. KSF takes a three pronged approach to this. It is working to develop sustainable eye-care within the country through building physical infrastructure. The second approach is to impact the current cataract backlog of over 300,000 patients with the aid of international support. Thirdly, KSF is paving the way for the next generation through the development of an optometry education programme and training of Cambodian ophthalmologists. Here we present the workings of KSF, clinical cases we have encountered and elaborate upon the future goals of this charity