Proposed Practice Change to Perform Ultrasound Lung Scans Immediately Following Upper Extremity Peripheral Nerve Blocks to Rule Out a Pneumothrax

Regional anesthesia is a technique that can be used for a variety of surgeries. There are risks involved when regional anesthesia is performed. Specifically when upper extremity nerve blocks are performed a potential complication is a pneumothorax. The purpose of this DNP project was to propose a practice change to perform ultrasound (US) lung scans immediately following upper extremity peripheral nerve blocks to rule out a pneumothorax. A needs assessment was conducted at the host facility to determine if the anesthesia providers were aware that US was a method that could be useful for detection of a pneumothorax. Currently, the majority of anesthesia providers at the host facility where the practice change was proposed are unaware that US lung scans are a useful and accurate method to detect a pneumothorax. The information collected from the literature review revealed that US was a technique that was more accurate, sensitive, and specific to diagnose a pneumothorax than CT. An evidence based presentation was presented to 10 anesthesia providers at a level II facility in the southeastern United States. Following the presentation, anesthesia providers completed a pre intervention survey and were asked to implement the practice change for a month. After a month, a post intervention survey was completed to determine if a practice change occurred. The results were evaluated by using descriptive statistics. The results of the project determined that 25% of the participants changed their practice to use US for detection of a pneumothorax following upper extremity nerve blocks

Incongruent counterparts and the absolute nature of space in Kant’s 1768 essay, "Directions in Space"

This article argues that Kant’s argument from incongruent counterparts in his essay, Directions in Space (1768) yields not the conclusion that space is an objective reality, but rather that it is an absolute and dynamical framework that grounds spatial properties, a view which is neutral with respect to the objective/subjective nature of space. It is suggested that, so construed, Kant’s argument in this essay can be made consistent with his later employment in support of transcendental idealism with regard to space

Unequal Racial Access to Kidney Transplantation

Access to medical care is an issue of acute and increasing importance in the United States, a country in which the most promising of ground-breaking technologies may be available to only the privileged few. Although debate about the problem of unequal access to medical care typically centers on financial obstacles to advanced therapies and the obvious inequity of allowing patients\u27 ability to pay to drive treatment decisions, issues of equitable access for patients of both genders and all racial and ethnic backgrounds increasingly have come into focus. These concerns about equitable access animate the ongoing debate about how government should regulate the transplantation of kidneys. More than 100,000 people in the United States suffer from kidney failure-what doctors call end-stage renal disease (ESRD). While kidney failure may be treated with dialysis,\u27 kidney transplantation is the preferred treatment: studies show that transplant recipients are more likely to return to work, avoid hospitalization, and enjoy a greater sense of well-being than patients on dialysis. Kidney transplants constitute more than three-fourths of the solid organ transplants performed in this country and have success rates routinely as high as eighty percent. A severe shortage of transplantable kidneys, however, limits the availability of this preferred treatment.\u27 For example, in 1990, while more than 18,000 Americans were registered on waiting lists, fewer than 8200 received renal transplants. Federal regulations control the allocation of scarce donated kidneys among prospective recipients. Since 1972, Medicare has covered the costs of virtually all kidney transplants. To qualify for Medicare reimbursement, transplanting hospitals must abide by rules promulgated by the federal Organ Procurement and Transplantation Network (OPTN). Current OPTN policies for cadaveric kidney allocation give strong preference to potential recipients who are genetically similar to the donor as determined by the identification of antigens located on the surface of cells. For example, if a harvested kidney has all the same antigens as a potential recipient on the waiting list, then that patient will receive the kidney-even if other dialysis patients have waited longer for a transplant

Unequal Racial Access to Kidney Transplantation

Access to medical care is an issue of acute and increasing importance in the United States, a country in which the most promising of ground-breaking technologies may be available to only the privileged few. Although debate about the problem of unequal access to medical care typically centers on financial obstacles to advanced therapies and the obvious inequity of allowing patients\u27 ability to pay to drive treatment decisions, issues of equitable access for patients of both genders and all racial and ethnic backgrounds increasingly have come into focus. These concerns about equitable access animate the ongoing debate about how government should regulate the transplantation of kidneys. More than 100,000 people in the United States suffer from kidney failure-what doctors call end-stage renal disease (ESRD). While kidney failure may be treated with dialysis,\u27 kidney transplantation is the preferred treatment: studies show that transplant recipients are more likely to return to work, avoid hospitalization, and enjoy a greater sense of well-being than patients on dialysis. Kidney transplants constitute more than three-fourths of the solid organ transplants performed in this country and have success rates routinely as high as eighty percent. A severe shortage of transplantable kidneys, however, limits the availability of this preferred treatment.\u27 For example, in 1990, while more than 18,000 Americans were registered on waiting lists, fewer than 8200 received renal transplants. Federal regulations control the allocation of scarce donated kidneys among prospective recipients. Since 1972, Medicare has covered the costs of virtually all kidney transplants. To qualify for Medicare reimbursement, transplanting hospitals must abide by rules promulgated by the federal Organ Procurement and Transplantation Network (OPTN). Current OPTN policies for cadaveric kidney allocation give strong preference to potential recipients who are genetically similar to the donor as determined by the identification of antigens located on the surface of cells. For example, if a harvested kidney has all the same antigens as a potential recipient on the waiting list, then that patient will receive the kidney-even if other dialysis patients have waited longer for a transplant

Robert Gaston: Art MFA Thesis

Documents submitted to the Faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Master of Fine Arts in the Department of Art.Master of Fine Art

iPTF13bvn: The First Evidence of a Binary Progenitor for a Type Ib Supernova

The recent detection in archival HST images of an object at the the location of supernova (SN) iPTF13bvn may represent the first direct evidence of the progenitor of a Type Ib SN. The object's photometry was found to be compatible with a Wolf-Rayet pre-SN star mass of ~11 Msun. However, based on hydrodynamical models we show that the progenitor had a pre-SN mass of ~3.5 Msun and that it could not be larger than ~8 Msun. We propose an interacting binary system as the SN progenitor and perform evolutionary calculations that are able to self-consistently explain the light-curve shape, the absence of hydrogen, and the pre-SN photometry. We further discuss the range of allowed binary systems and predict that the remaining companion is a luminous O-type star of significantly lower flux in the optical than the pre-SN object. A future detection of such star may be possible and would provide the first robust identification of a progenitor system for a Type Ib SN.Comment: Accepted to AJ on July 26. Slight changes from original, however delayed by slow refereeing proces

White Matter Abnormalities in Patients with Treatment-Resistant Genetic Generalized Epilepsies.

BACKGROUND Genetic generalized epilepsies (GGEs) are associated with microstructural brain abnormalities that can be evaluated with diffusion tensor imaging (DTI). Available studies on GGEs have conflicting results. Our primary goal was to compare the white matter structure in a cohort of patients with video/EEG-confirmed GGEs to healthy controls (HCs). Our secondary goal was to assess the potential effect of age at GGE onset on the white matter structure. MATERIAL AND METHODS A convenience sample of 23 patients with well-characterized treatment-resistant GGEs (13 female) was compared to 23 HCs. All participants received MRI at 3T. DTI indices, including fractional anisotropy (FA) and mean diffusivity (MD), were compared between groups using Tract-Based Spatial Statistics (TBSS). RESULTS After controlling for differences between groups, abnormalities in DTI parameters were observed in patients with GGEs, including decreases in functional anisotropy (FA) in the hemispheric (left>right) and brain stem white matter. The examination of the effect of age at GGE onset on the white matter integrity revealed a significant negative correlation in the left parietal white matter region FA (R=-0.504; p=0.017); similar trends were observed in the white matter underlying left motor cortex (R=-0.357; p=0.103) and left posterior limb of the internal capsule (R=-0.319; p=0.148). CONCLUSIONS Our study confirms the presence of widespread white matter abnormalities in patients with GGEs and provides evidence that the age at GGE onset may have an important effect on white matter integrity