Acute Agitation Intervention Tool for Reduction of Polypharmacy

Introduction: Patients with behavioral health diagnoses are among the highest risk foraggression. For pediatric patients with behavioral health needs, urgent treatment isneeded for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guidepharmacological intervention for mild and moderate to severe agitation in pediatricpatients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period. Methods: This QI included a retrospective analysis of PRN medications pre (Oct. 2022-Dec. 2022) and post (Jan 2023-Mar 2023) implementation of the Acute AgitationIntervention Tool using the BVC to inform pharmacological intervention. The IowaModel Revised: Evidence-Based Practice to Promote Excellence in Health Care was the framework. Results: A (N=337) agitation occurred when combining the pre and post-implementation periods. Pre-Implementation (n=237) Post Implementation (n=100). Adecrease in the number of medications utilized per agitation event by 6.6% was found. A two-tailed independent sample t-test was performed. Implication for practice: Continued utilization of the Acute Agitation Intervention Tool,modifying the tool to self-injurious behaviors, continual support, and audits of thoseadministering the medication of the order set will be completed. There will continue to be areas of opportunity for improvement in aggression assessment and PRN medication practice

A comparison of time domain boundary conditions for acoustic waves in wave guides

Researchers consider several types of boundary conditions in the context of time domain models for acoustic waves. Experiments with four different duct terminations (hard wall, free radiation, foam, and wedge) were carried out in a wave duct from which reflection coefficients over a wide frequency range were measured. These reflection coefficients were used to estimate parameters in the time domain boundary conditions. A comparison of the relative merits of the models in describing the data is presented. Boundary conditions which yield a good fit of the model to the experimental data were found for all duct terminations except the wedge

Theoretical and experimental studies of the underlying processes and techniques of low pressure measurement Letter report, 1 Jul. 1967 - 31 May 1968

Ionization gage behavior in various gas mixtures and atmospheric composition

Theoretical and experimental studies of the underlying processes and techniques of low pressure measurement Progress report, 1 Jun. 1966 - 31 May 1967

Construction, testing, and refining of vacuum gauges - ionization gauge cross section ratio

Distinct roles of c-Jun N-terminal kinase isoforms in neurite initiation and elongation during axonal regeneration

c-Jun N-terminal kinases (JNKs) (comprising JNK1-3 isoforms) are members of the MAPK (mitogen-activated protein kinase) family, activated in response to various stimuli including growth factors and inflammatory cytokines. Their activation is facilitated by scaffold proteins, notably JNK-interacting protein-1 (JIP1). Originally considered to be mediators of neuronal degeneration in response to stress and injury, recent studies support a role of JNKs in early stages of neurite outgrowth, including adult axonal regeneration. However, the function of individual JNK isoforms, and their potential effector molecules, remained unknown. Here, we analyzed the role of JNK signaling during axonal regeneration from adult mouse dorsal root ganglion (DRG) neurons, combining pharmacological JNK inhibition and mice deficient for each JNK isoform and for JIP1. We demonstrate that neuritogenesis is delayed by lack of JNK2 and JNK3, but not JNK1. JNK signaling is further required for sustained neurite elongation, as pharmacological JNK inhibition resulted in massive neurite retraction. This function relies on JNK1 and JNK2. Neurite regeneration of jip1(-/-) DRG neurons is affected at both initiation and extension stages. Interestingly, activated JNKs (phospho-JNKs), as well as JIP1, are also present in the cytoplasm of sprouting or regenerating axons, suggesting a local action on cytoskeleton proteins. Indeed, we have shown that JNK1 and JNK2 regulate the phosphorylation state of microtubule-associated protein MAP1B, whose role in axonal regeneration was previously characterized. Moreover, lack of MAP1B prevents neurite retraction induced by JNK inhibition. Thus, signaling by individual JNKs is differentially implicated in the reorganization of the cytoskeleton, and neurite regeneration

Consecutive wildfires affect stream biota in cold- and warmwater dryland river networks

Citation: Whitney, J. E., Gido, K. B., Pilger, T. J., Propst, D. L., & Turner, T. F. (2015). Consecutive wildfires affect stream biota in cold- and warmwater dryland river networks. Freshwater Science, 34(4), 1510-1526. doi:10.1086/683391Climate change and fire suppression have altered fire regimes globally, leading to larger, more frequent, and more severe wildfires. Responses of coldwater stream biota to single wildfires are well studied, but measured responses to consecutive wildfires in warmwater systems that often include mixed assemblages of native and nonnative taxa are lacking. We quantified changes in physical habitat, resource availability, and biomass of cold- and warmwater oligochaetes, insects, crayfish, fishes, and tadpoles following consecutive megafires (covering >100 km(2)) in the upper Gila River, New Mexico, USA. We were particularly interested in comparing responses of native and nonnative fishes that might have evolved under different disturbance regimes. Changes in habitat and resource availability were related to cumulative fire effects, fire size, and postfire precipitation. The 2nd of 2 consecutive wildfires in the basin was larger and, coupled with moderate postfire discharge, resulted in increased siltation and decreased algal biomass. Several insect taxa responded to these fires with reduced biomass, whereas oligochaete biomass was unaffected. Biomass of 6 of 7 native fish species decreased after the fires, and decreases were associated with site proximity to fire. Nonnative fish decreases after fire were most pronounced for coldwater salmonids, and warmwater nonnative fishes exhibited limited responses. All crayfish and tadpoles collected were nonnative and were unresponsive to fire disturbance. More pronounced responses of native insects and fishes to fires indicate that increasing fire size and frequency threatens the persistence of native fauna and suggests that management activities promoting ecosystem resilience might help ameliorate wildfire effects

Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis

Importance: The ε4 allele of the apolipoprotein E (APOE) gene and lower apolipoprotein E (apoE) protein levels in plasma are risk factors for Alzheimer disease, but the underlying biological mechanisms are not fully understood. Half of plasma apoE circulates on high-density lipoproteins (HDLs). Higher apoE levels in plasma HDL were previously found to be associated with lower coronary heart disease risk, but the coexistence of another apolipoprotein, apoC3, modified this lower risk. Objective: To investigate associations between the presence of apoE in different lipoproteins with cognitive function, particularly the risk of dementia. Design, Setting, and Participants: This prospective case-cohort study embedded in the Ginkgo Evaluation of Memory Study (2000-2008) analyzed data from 1351 community-dwelling participants 74 years and older. Of this group, 995 participants were free of dementia at baseline (recruited from September 2000 to June 2002) and 521 participants were diagnosed with incident dementia during follow-up until 2008. Data analysis was performed from January 2018 to December 2019. Exposures: Enzyme-linked immunosorbent assay–measured concentration of apoE in whole plasma, HDL-depleted plasma (non-HDL), HDL, and HDL subspecies that contain or lack apoC3 or apoJ. Main Outcomes and Measures: Adjusted hazard ratios for risk of dementia and Alzheimer disease during follow-up and adjusted differences (β coefficients) in Alzheimer Disease Assessment–Cognitive Subscale (ADAS-cog) and Modified Mini-Mental State Examination scores at baseline. Results: Among 1351 participants, the median (interquartile range) age was 78 (76-81) years; 639 (47.3%) were women. The median (interquartile range) follow-up time was 5.9 (3.7-6.5) years. Higher whole plasma apoE levels and higher apoE levels in HDL were associated with better cognitive function assessed by ADAS-cog (whole plasma, β coefficient, −0.15; 95% CI, −0.24 to −0.06; HDL, β coefficient, −0.20; 95% CI, −0.30 to −0.10) but were unassociated with dementia or Alzheimer disease risk. When separated by apoC3, a higher apoE level in HDL that lacks apoC3 was associated with better cognitive function (ADAS-cog per SD: β coefficient, 0.17; 95% CI, −0.27 to −0.07; Modified Mini-Mental State Examination score per SD: β coefficient, 0.25; 95% CI, 0.07 to 0.42) and lower risk of dementia (hazard ratio per SD, 0.86; 95% CI, 0.76 to 0.99). In contrast, apoE levels in HDL that contains apoC3 were unassociated with any of these outcomes. Conclusions and Relevance: In a prospective cohort of older adults with rigorous follow-up of dementia, the apoE level in HDL that lacked apoC3 was associated with better cognitive function and lower dementia risk. This finding suggests that the cardioprotective associations of this novel lipoprotein extend to dementia

Cirrhosis-induced defects in innate pulmonary defenses against Streptococcus pneumoniae

<p>Abstract</p> <p>Background</p> <p>The risk of mortality from pneumonia caused by <it>Streptococcus pneumoniae </it>is increased in patients with cirrhosis. However, the specific pneumococcal virulence factors and host immune defects responsible for this finding have not been clearly established. This study used a cirrhotic rat model of pneumococcal pneumonia to identify defect(s) in innate pulmonary defenses in the cirrhotic host and to determine the impact of the pneumococcal toxin pneumolysin on these defenses in the setting of severe cirrhosis.</p> <p>Results</p> <p>No cirrhosis-associated defects in mucociliary clearance of pneumococci were found in these studies, but early intrapulmonary killing of the organisms before the arrival of neutrophils was significantly impaired. This defect was exacerbated by pneumolysin production in cirrhotic but not in control rats. Neutrophil-mediated killing of a particularly virulent type 3 pneumococcal strain also was significantly diminished within the lungs of cirrhotic rats with ascites. Levels of lysozyme and complement component C3 were both significantly reduced in bronchoalveolar lavage fluid from cirrhotic rats. Finally, complement deposition was reduced on the surface of pneumococci recovered from the lungs of cirrhotic rats in comparison to organisms recovered from the lungs of control animals.</p> <p>Conclusion</p> <p>Increased mortality from pneumococcal pneumonia in this cirrhotic host is related to defects in both early pre-neutrophil- and later neutrophil-mediated pulmonary killing of the organisms. The fact that pneumolysin production impaired pre-neutrophil-mediated pneumococcal killing in cirrhotic but not control rats suggests that pneumolysin may be particularly detrimental to this defense mechanism in the severely cirrhotic host. The decrease in neutrophil-mediated killing of pneumococci within the lungs of the cirrhotic host is related to insufficient deposition of host proteins such as complement C3 on their surfaces. Pneumolysin likely plays a role in complement consumption within the lungs. Our studies, however, were unable to determine whether pneumolysin more negatively impacted this defense mechanism in cirrhotic than in control rats. These findings contribute to our understanding of the defects in innate pulmonary defenses that lead to increased mortality from pneumococcal pneumonia in the severely cirrhotic host. They also suggest that pneumolysin may be a particularly potent pneumococcal virulence factor in the setting of cirrhosis.</p

The Black Feminist Mixtape: A Collective Black Feminist Autoethnography of Black Women\u27s Existence in the Academy

Seven Black women graduate students from across different functional areas of higher education work in solidarity to write a collective Black Feminist Autoethnography (BFA) (Griffin, 2012) about our experiences at our respective colleges and universities. BFA is a theoretical and methodological means for Black female academics to critically narrate the pride and pain of Black womanhood (Griffin, 2012, p. 1). This article centers Black feminist scholarship as a framework to reflexively interpret how we as seven Black women navigate within, against, and beyond the academy to address dominant narratives that affect our professional and personal experiences. We use contemporary music lyrics and poems by Black women to actively illustrate and interrogate our individual and collective positionalities to promote critical literacy. Together, we are seven Black sista scholars who reclaim our voice as legitimized epistemologies in academic spaces. Hear Our Voices