Implementing Nurse-Specialist-Delivered-Education to Improve Application Compliance of Ordered Intermittent Pneumatic Compression

Healthcare-associated (HA) venous thromboembolism (VTE) is the formation of a potentially deadly blood clot that can occur in patients as a result of hospitalization, surgery, procedures, etc. (Centers for Disease Control and Prevention, 2022a). HA-VTE is the number one most preventable cause of death in hospitals. The organization at which this author is associated experienced 48 VTE events during the first six months of 2020 (Mainer, 2020). Over 50% of these events demonstrate a lack of appropriate physical or mechanical VTE prophylaxis application per provider order, including sequential compression devices (SCD). The use of intermittent pneumatic compression devices (IPCD) (i.e., SCDs) have been proven to reduce the risk of HA-VTE (Fan et al., 2020). However, these devices are underutilized in practice (Kakkos et al., 2016). This evidence-based practice (EBP) research project seeks to determine if nurse-specialist-delivered education about IPC effectiveness to nurses and patients who have SCD orders can improve SCD compliance rates. Two cycles of the Plan-Do-Study-Act model of EBP project implementation are utilized to implement two VTE education tools developed per evidence obtained via review of the literature. These education methods include a VTE nurse education PowerPoint presentation and VTE patient education tool. Post-intervention audits demonstrate a small increase in SCD application compliance compared to baseline

Energy Return Characteristics of EVA and E-TPU Midsoles During a Drop Jump

Expanded Thermoplastic Polyurethane (E-TPU) is a material used in shoe midsoles that has been described as having greater energy return than traditional Ethylene Vinyl-Acetate (EVA) midsole material. PURPOSE: The purpose of this study was to compare the landing and energy return characteristics of shoes using EVA and E-TPU midsoles. METHODS: Ten collegiate female athletes (19.7±1.0 yrs, 75.74±10.9 kg, 1.72±0.08 m) volunteered and provided informed consent to participate in this study. Participants performed five drop jumps from a height of 50 cm under two conditions; while wearing EVA midsole shoes and while wearing E-TPU midsole shoes. Peak force, rate of loading and impulse were measured from a Bertec force plate sampled at 1000 Hz during the initial landing phase of the drop jump. Coefficient of Restitution (COR) was determined by measuring the bounce height of a 1 in steel ball bearing dropped from a 1 m height onto the shoes. All measures were compared between midsole conditions using paired t-tests. RESULTS: Peak vertical force when landing with the EVA shoe (3265.6±554.2 N) was not different (p=0.19) than when landing with the E-TPU shoe (3406.6± 590.3 N). Similar rates of loading (p=0.71) were found for the EVA shoes (56106.3±9995.8 N/s) and the E-TPU shoes (54232.4±12167.0). Likewise impulse was not different (p=0.30) between the EVA shoe (710.5±177.7 Ns) and E-TPU shoe (693.9±162.6 Ns). However, COR was slightly higher (p=0.01) in the E-TPU shoe (0.67±.05) than the EVA shoe (0.66±0.02). CONCLUSION: The difference in COR values coupled with the similar landing characteristics observed for the different midsole materials may suggest that individuals are able to compensate for material differences by using different physiological strategies such as using different muscle stiffness during the landing phase depending on midsole material. Further testing to examine physiological measures during these movements is warranted

Meta-analysis of the efficacy of a single stage laparoscopic management versus two-stage endoscopic management of symptomatic gallstones with common bile duct stones.

Background. The optimal treatment of gallstones with associated common bile duct stones in the laparoscopic era is controversial. Various reviews and decision based algorithms have been published, but the superior treatment modality is unclear. Therefore, a metaanalysis was conducted to compare the two most commonly used treatment strategies. Methods. A systematic review was conducted to compare single stage laparoscopic cholecystectomy with common bile duct exploration versus a combined endoscopic and laparoscopic treatment. Eligible studies were identified using a search of Medline, Embase, Cochrane and Science Citation Index Expanded databases. Appropriately selected articles were independently reviewed and data was extracted and cross referenced. A meta-analysis was conducted of the pooled trial data to determine difference in outcomes. Results. A total of seven randomized trials were identified with 746 patients with 366 in the laparoscopic only treatment group and 380 in the combined endoscopic and laparoscopic treatment arms. There was no significant difference in successful bile duct clearance between the two groups (OR 1.23; 95% CI 0.55 to 2.75, P = 0.61). There was no statistical difference in morbidity (RR 1.23; 95% CI 0.92 to 1.66; P = 0.17), mortality (RD -0.00; 95% CI -0.02 to 0.01, P = 0.59) or length of hospital stay (MD -0.31; 95% CI -1.68 to 1.06, P = 0.66). However, there was a statistically significant difference in the duration of procedure in favour of the single stage laparoscopic treatment (MD -6.83; 95% CI -9.59 to -4.07, P \u3c 0.00001). Conclusion. Both the laparoscopic alone or the combined endoscopic and laparoscopic treatment approaches show comparative efficacy in management of symptomatic gallstones with associated choledocholithiasis

A Weakly Supervised Approach for Estimating Spatial Density Functions from High-Resolution Satellite Imagery

We propose a neural network component, the regional aggregation layer, that makes it possible to train a pixel-level density estimator using only coarse-grained density aggregates, which reflect the number of objects in an image region. Our approach is simple to use and does not require domain-specific assumptions about the nature of the density function. We evaluate our approach on several synthetic datasets. In addition, we use this approach to learn to estimate high-resolution population and housing density from satellite imagery. In all cases, we find that our approach results in better density estimates than a commonly used baseline. We also show how our housing density estimator can be used to classify buildings as residential or non-residential.Comment: 10 pages, 8 figures. ACM SIGSPATIAL 2018, Seattle, US

Bioresorbable Polylactide Interbody Implants in an Ovine Anterior Cervical Discectomy and Fusion Model: Three-Year Results

Study Design. In vivo study of anterior discectomy and fusion using a bioresorbable 70:30 poly(l-lactide-co-d,l-lactide) interbody implant in an ovine model. Objective. To evaluate the efficacy of the polylactide implant to function as an interbody fusion device, and to assess the tissue reaction to the material during the resorption process. Summary of Background Data. The use of polylactide as a cervical interbody implant has several potential advantages when compared with traditional materials. Having an elastic modulus very similar to bone minimizes the potential for stress shielding, and as the material resorbs additional loading is transferred to the developing fusion mass. Although preclinical and clinical studies have demonstrated the suitability of polylactide implants for lumbar interbody fusion, detailed information on cervical anterior cervical discectomy and fusion (ACDF) with polylactide devices is desirable. Methods. Single level ACDF was performed in 8 skeletally mature ewes. Bioresorbable 70:30 poly (l-lactide-co-d,l-lactide) interbody implants packed with autograft were used with single-level metallic plates. Radiographs were made every 3 months up to 1 year, and yearly thereafter. The animals were killed at 6 months (3 animals), 12 months (3 animals), and 36 months (2 animals). In addition to the serial plain radiographs, the specimens were evaluated by nondestructive biomechanical testing and undecalcified histologic analysis. Results. The bioresorbable polylactide implants were effective in achieving interbody fusion. The 6-month animals appeared fused radiographically and biomechanically, whereas histologic sections demonstrated partial fusion (in 3 of 3 animals). Radiographic fusion was confirmed histologically and biomechanically at 12 months (3 of 3 animals) and 36 months (2 of 2 animals). A mild chronic inflammatory response to the resorbing polylactide implant was observed at both 6 months and 12 months. At 36 months, the operative levels were solidly fused and the implants were completely resorbed. No adverse tissue response was observed in any animal at any time period. Conclusion. Interbody fusion was achieved using bioresorbable polylactide implants, with no evidence of implant collapse, extrusion, or adverse tissue response to the material. The use of polylactide as a cervical interbody device appears both safe and effective based on these ACDF animal model results

Budd-Chiari syndrome recurring in a transplanted liver

A patient with Budd-Chiari syndrome who underwent orthotopic liver transplantation and developed recurrent disease is described. The immediate postoperative period was complicated by multiple thrombotic episodes, followed by a period of apparent remission associated with the initiation of coumadin and persantine therapy. After discontinuation of such antithrombotic therapy in order to biopsy the liver, the patient experienced another series of clinically overt vascular thromboses and ultimately died of sepsis 15 mo posttransplantation after a prolonged and complicated terminal hospital course. At autopsy, recurrent Budd-Chiari syndrome as well as thromboses in numerous other organs was demonstrated. © 1983

Pengendalian Biaya Dan Waktu Dengan Metode Analisis Nilai Dan Hasil Dengan Microsoft Project 2010 (Studi Kasus : Gedung Mantos Tahap III)

Pengendalian dalam proyek merupakan fungsi paling pokok dama pelaksanaan suatu proyek konstruksi. Pengendalian sebagai alat untuk membantu mengendalikan proyek, membantu pelaksanaan dan penyelesaian dalam suatu proyek konstruksi. Pelaksanaan suatu proyek umumnya sering terjadi penyimpanan – penyimpangan dimana biaya yang dikeluarkan dan jadwal yang direncanakan melampaui batas yang direncanakan. Pengendalian proyek bertujuan untuk mengendaliakn biaya dan waktu agar sesuai dengan biaya dan jadwal yang direncanakan. Metode nilai hasil merupakan pengembangan teknik pengendalian grafik S sampai mampu menganalisis varians biaya secara stimulant sehingga dapat melihat kemajuan proyek dari jadwal dengan anggaran yang telah dialokasikan. Metode nilai hasil ini mencakup rencana anggaran dan biaya (RAB), daftar harga satuan upah dan bahan, analisa harga satuan serta laporan kemajuan proyek di olah untuk mendapatkan BCWS (Budgeted Cost of Work Schedule), ACWP (Actual Cost of Work Performance) dan BCWP (Budgeted Cost of Work Performance) Dari hasil penerapan metode konsep nilai hasil diketahui sampai hasil tinjauan pada minggu ke 6 di dapatkan BCWS = Rp. 46,932,747,947.29; ACWP = Rp. 45,928,815,000.00; BCWP = Rp. 47,633,716,500.77; sedangkan varian biaya (CV) pada bulan satu sampai tiga adalah negative (-) dan pada bulan ke empat sampai akhir pelaksanaan proyek adalah positif (+) begitu pun varian jadwal. Dan dapat diketahui prakiraan biaya akhir proyek EAC (Estimate At Complection) adalah Rp. 70,829,440,000.00, dengan anggaran rencana sebesar Rp. 72,391,666,414.54. Estimate Complection Date (ECD) proyek mengalami sedikit kemajuan terhadap jadwal yang direncanakan yaitu 2 har