Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians

Introduction: We conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.Methods: Through content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4-6 hours.Results: We approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.Conclusion: Patient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints

Aspectos económicos y ambientales para la creación de empresa en Nicaragua

Este documento inicia abordando los Aspectos Económicos a considerar en la creación de empresas de manera que sirvan de apoyo para los creadores o formadores de empresas, contiene un buen número de aplicaciones que no pueden obviar, se enfatiza en las política económicas, que apoyan el desarrollo y crecimiento de la inversión con el fin de alcanzar desarrollo económico. En el capítulo I del desarrollo, trataremos los aspecto a considerar en la creación de empresas para la puesta en práctica de los Pequeños, Medianos y Grandes Inversionistas a mantener un poco la estabilidad económica en este tiempo de poca confiabilidad, es decir profundizar algunos aspecto que por lo general no se analizan ni se profundizan, debido a esto y otros factores se crean empresas y no logran la estabilidad en el mercado. En el capítulo II haremos un enfoque del Ambiente Organizacional que debe mantenerse dentro de la organización, por consiguiente debe considerarse un buen clima y una cultura, así mismo el desarrollo organizacional, para que sus efecto en todo en las operaciones de la organización logren al máximo la eficiencia y la productividad que se haya proyectad

Engagement and Disengagement in Art Interventions with Memory Impairment

Introduction. Studies have shown art intervention to be an effective therapy for patients with memory impairments, leading to overall positive behaviors, increased quality of life and decreased caregiver burden. We conducted a preliminary study to evaluate and compare the effect of participation in weekly art appreciation and painting sessions on the behavior of memory impaired residents in an assisted living facility. Methods. Residents’ behaviors were observed during art appreciation and active painting sessions over a six-week period. Each session consisted of either viewing and discussing artwork or actively painting in the style of the artist discussed. Positive and negative behaviors were recorded and tallied throughout the sessions. Over the course of 12 sessions, the 7 observers made a total of 1957 observations of a variable patient population. The total number of both positive and negative behaviors was compared between activities, over time within sessions, as well as over the six weeks. Each session was percent normalized to the time interval with the highest occurrence of select behaviors. Results. Upward trends for positive and negative behaviors were noticed in ap- preciation and painting sessions respectively. The negative to positive engagements ratios for each painting session showed an increase in negative behaviors. Disengagement increased as the appreciation sessions progressed and decreased as painting sessions progressed. Overall, positive engagement increased in both appreciation and painting sessions. Conclusions. Despite several confounding variables encountered in this study, we demonstrated art appreciation and active painting to be a viable non- pharmacological therapeutic approach for individuals with memory impairments.https://scholarworks.uvm.edu/comphp_gallery/1258/thumbnail.jp

Simulation of the synergistic low Earth orbit effects of vacuum thermal cycling, vacuum UV radiation, and atomic oxygen

In order to assess the low Earth orbit (LEO) durability of candidate space materials, it is necessary to use ground laboratory facilities which provide LEO environmental effects. A facility combining vacuum thermal cycling and vacuum ultraviolet (VUV) radiation has been designed and constructed at NASA Lewis Research Center for this purpose. This facility can also be operated without the VUV lamps. An additional facility can be used to provide VUV exposure only. By utilizing these facilities, followed by atomic oxygen exposure in an RF plasma asher, the effects of the individual vacuum thermal cycling and VUV environments can be compared to the effect of the combined vacuum thermal cycling/VUV environment on the atomic oxygen durability of materials. The synergistic effects of simulated LEO environmental conditions on materials were evaluated by first exposing materials to vacuum thermal cycling, VUV, and vacuum thermal cycling/VUV environments followed by exposure to atomic oxygen in an RP plasma asher. Candidate space power materials such as atomic oxygen protected polyimides and solar concentrator mirrors were evaluated using these facilities. Characteristics of the Vacuum Thermal Cycling/VUV Exposure Facility which simulates the temperature sequences and solar ultraviolet radiation exposure that would be experienced by a spacecraft surface in LEO are discussed. Results of durability evaluations of some candidate space power materials to the simulated LEO environmental conditions will also be discussed. Such results have indicated that for some materials, atomic oxygen durability is affected by previous exposure to thermal cycling and/or VUV exposure

Biomonitoring of airborne fluoride and polycyclic aromatic hydrocarbons in industrial areas of Cordoba, Argentina, using standardized grass cultures of Lolium multiflorum

A biomonitoring study was performed employing standardized grass cultures. Plants of Lolium multiflorum were exposed at 4 industrial sites over three?month periods in two seasons (dry and rainy) and the biomass produced was used for subsequent measurements of fluoride, polycyclic aromatic hydrocarbons (phenanthrene, anthracene, pyrene, benzo[a]anthracene, chrysene, benzo[b]fluoranthene, benzo[k]fluoranthene, benzo[a]pyrene, dibenzo[a,h]‐ anthracene and benzo[g,h,i]perylene), total chlorophyll, malondialdehyde, water, and sulfur content. The total content of polycyclic aromatic hydrocarbons (PAHs) revealed seasonal variations, with the highest values corresponding to the dry season, although this species showed a high retention capacity of PAHs during rainy season. In addition, sampling sites with high vehicular traffic and metal?mechanical industries were associated with the highest content of PAHs. Furthermore, physiological degradation associated with anthropogenic activities in the sampling sites was observed. Fluoride content in the biomonitor was associated with the production and use ofcement, which was higher in the dry season.Fil: Rodriguez, Judith Hebelen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Wannaz, Eduardo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Franzaring, Jurgen. Universidad de Hohenheim. Instituto de Paisaje y Ecología Vegetal. Especialidad En Ecología Vegetal y Ecotoxicologia; AlemaniaFil: Klumpp, Andreas. Universidad de Hohenheim. Instituto de Paisaje y Ecología Vegetal. Especialidad En Ecología Vegetal y Ecotoxicologia; AlemaniaFil: Fangmeier, Andreas. Universidad de Hohenheim. Instituto de Paisaje y Ecología Vegetal. Especialidad En Ecología Vegetal y Ecotoxicologia; AlemaniaFil: Pignata, Maria Luisa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentin

Imaginarios colectivos de la violencia de los habitantes del Municipio de Pasto

Este trabajo de investigación, es una aproximación al análisis de la violencia colombiana en sus múltiples manifestaciones, expresadas por rostros humanos, cargados de terror, que no quieren seguir siendo las víctimas incondicionales de este terrible mal que se ha apoderado del país. Es una descripción y significación de los imaginarios de la violencia, que toma como pretexto a los habitantes del municipio de Pasto, para ser vista por los niños y adolescentes, mujeres y habitantes de la calle, ejecutivos y religiosos, guerrilleros, excombatientes y militares, quienes desde su perspectiva opinaron acerca de este fenómeno. En síntesis, los capítulos que aquí se presentan son, en primer lugar, la Justificación, que radica principalmente en la posibilidad de aportar una visión de la realidad del colectivo social, centrándose básicamente en el impacto de esta investigación. En segundo lugar, se hace una descripción de los Antecedentes del proyecto, en donde se citan brevemente algunos estudios de violencia que aportan en la construcción social desde lo local

Multidisciplinary study of chemical and biological factors related to lead accumulation in sorghum crops grown in contaminated soils and their toxicological implications

In this study, the content of Pb, the physico-chemical and biological parameters in soils, and the metal transfer to vegetative and reproductive Sorghum bicolor plants were evaluated along with their relationship with the toxicological risk of crop consumption. To carry this out, soil and sorghum samples at different growth stages were collected near to a former battery recycling plant. The results showed that the concentrations of Pb in soils at several sites were above the maximum permissible levels. Metal bioavailability was not directly related to the pH, OM% or EC, while no association between metals and the different genera of fungi was observed. Sorghum crops accumulated Pb mainly in the roots in all of the growth stages, and therefore presented low levels of Pb in aerial parts without toxicological risk due to direct consumption. Taken together, our results revealed that sorghum could be employed as a potential phytostabilizator of lead in soils associated with crop production. However, further studies are necessary to extend these findings.Fil: Blanco, Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Salazar, María Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Vergara Cid, Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Pereyra, Carina Maricel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Universidad Nacional de Río Cuarto; ArgentinaFil: Cavaglieri, Lilia Reneé. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Universidad Nacional de Río Cuarto; ArgentinaFil: Becerra, Alejandra Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Pignata, Maria Luisa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Rodriguez, Judith Hebelen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; Argentin

Biomonitoring of atmospheric trace elements in agricultural areas and a former uranium mine

Most biomonitoring studies worldwide have evaluated the air quality in industrial and urban areas, and even in mining areas to a lesser extent. However, air quality investigations in agricultural areas are scarce. In the present study, the trace metal accumulation and physiological response of the biomonitor Tillandsia capillaris were assessed. Plant samples were transplanted to a reference site, a former open-cast uranium mine, and agricultural sites with varying pollution levels (from normal agricultural practices and near an open rubbish dump) in the province of Córdoba, Argentina. Biomonitors were exposed to ambient air for different exposure periods for physiological or trace element determination. The bioindicators revealed that the highest physiological damage occurred at the sites close to the open dump and the former uranium mine, while a comparison among exposure periods indicating the winter season produced the highest physiological damage in the biomonitor due to the adverse climatic conditions and air pollution. As the trace metal accumulation in the biomonitor was mainly associated with the open dump and uranium mine sites, monitoring and remediation programs should now be applied to these sites in order to alleviate the negative effects of pollution on the environment and the population.Fil: Rodriguez, Judith Hebelen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Wannaz, Eduardo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Weller, Sebastian Benjamin. Karlsruher Institut Fur Technologie; AlemaniaFil: Pignata, María Luisa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; Argentin