Dual Component Educational Program to Improve Medical-Surgical Nurses’ Knowledge and Self-Efficacy of Severe Sepsis and Septic Shock

Sepsis is manifested by a spectrum of clinical signs and symptoms that are produced by an immune response to an infection. The continuum of sepsis ranges from simple sepsis to septic shock and without timely and appropriate intervention leads to death. The purpose of this practice inquiry project is to implement a dual component educational program at Baptist Health Madisonville, a hospital part of the Baptist Healthcare System in Madisonville, Kentucky, and evaluate the changes in nurse knowledge and self-efficacy levels after they receive didactic and interactive education. The first manuscript is an integrative literature review of studies published between 2005 and 2014 that have implemented educational interventions utilizing simulation in the acute care setting specifically on medical-surgical units. The findings from this review revealed a surprising knowledge gap in the use of high fidelity simulation outside the academic setting and whether this level of fidelity is cost effective or superior to lower levels of fidelity. The study recommends healthcare organizations utilize low to medium fidelity simulation in an effort to increase the engaging experiences of staff nurses. The second manuscript serves to analyze the Surviving Sepsis Campaign (SSC) Guidelines for management of severe sepsis and septic shock using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Using the Agree II Instrument facilitates a quality guideline assessment in terms of scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. The final manuscript is a write up of the results of implementing a pilot educational program that includes both didactic and simulation experiences in an attempt to improve the knowledge and self-efficacy levels of medical-surgical registered nurses so that they may better recognize patient deterioration, specifically from sepsis, and respond appropriately and expediently

Vocabulary analysis of seven arithmetic textbooks for primary grades

Thesis (Ed.M.)--Boston Universit

ASTROCYTE-ENDOTHELIAL INTERACTIONS: IMPLICATIONS FOR HIV-ASSOCIATED NEUROCOGNITIVE DISORDER

During the course of HIV-1 disease, virus neuroinvasion occurs as an early event, within weeks following infection. Intriguingly, subsequent central nervous system (CNS) complications manifest only decades after the initial virus exposure. In the current era of combined anti-retroviral therapy (cART), while the virus replication in the periphery is brought under complete control, in the CNS owing to poor drug penetrance, there occurs development of increasing neurocognitive complications. So while the HIV-infected patients are living longer and have decreased incidence of the disease, the prevalence of HIV-associated neurocognitive disorders (HAND) is actually on a rise. Although CNS is commonly regarded as an immune-privileged site, emerging evidence indicates that innate immunity elicited by the CNS glial cells is a critical determinant for the establishment of protective immunity. Sustained expression of the protective immune responses manifested as increased expression of a mediator, such as platelet-derived growth factor (PDGF), however, can be a double-edged sword. While PDGF has been defined as a neuroprotective immune mediator, in concert with other inflammatory mediators (elicited by HIV or its protein products), it can tip the balance from a protective to a toxic state in the CNS. Herein, we present an overview of some of the essential elements of the cerebral innate immunity in HIV neuropathogenesis including the role that platelet-derived growth factor (PDGF) released from astrocytes has in exacerbating HAND. Out of the various PDGF isoforms, PDGF-BB is critical for astrocytes and hence is the focus of our study. PDGF-BB exposure to astrocytes results in astrogliosis and release of the chemokine monocyte chemotactic protein-1 (MCP-1), the two hallmark features of HAND. To further understand these observations and explore the role of PDGF-BB regulation in HAND, our central hypothesis is that exposure of astrocytes to HIV transactivating protein Tat results in the release of growth factors such as PDGF-BB, which could ultimately lead to enhanced astrogliosis and blood-brain barrier(BBB) disruption. The aim of this study was to explore the mechanism of PDGF-BB regulation in astrocytes as it relates to HAND pathogenesis

Feasibility of a New Indiana Coordinate Reference System (INCRS)

Engineers, Surveyors, and GIS Professionals spend an enormous amount of time correcting field surveys to the classical State Plane Coordinate System (SPCS). The current mapping corrections are in the order of 1:33,000, or 30 parts per million (ppm). Modern surveys (e.g., GPS/InCORS) have an accuracy of a few parts per million. Whenever original surveys made on the surface of the Earth need to be reduced to a mapping reference surface, surveyed distances and angles (azimuths) need to be corrected. Measured distances need to be corrected for two scale factors: 1) due to the mapping scale inherent in conformal mappings, and 2) due to terrain heights. Measured angles (azimuths) need to be corrected for so-called convergence angles. The application of these necessary corrections is time consuming and may add an estimated 15 to 20% to the cost of a survey. The omission of these corrections corrupts the reliability of survey results. A new Indiana Coordinate Reference System (INCRS) allows for so much smaller corrections that when omitted the errors committed are small, and may be even neglected for surveys less accurate than a few ppm. In a few areas of Indiana (e.g. Clark County), terrain heights corrections are still needed because these corrections due to the terrain roughness are at the 14 ppm level. Not only reduces the proposed INCRS reduces the scale factor from 30 ppm to a few ppm, but also the convergence angles are reduced by a factor of four (from about 0.5 degree to about 7-8 arcminutes)

Laser Mobile Mapping Standards and Applications in Transportation

This report describes the work that was done to support the development of a chapter for the INDOT Survey Manual on Mobile Mapping. The work includes experiments that were done, data that was collected, analysis that was carried out, and conclusions that were drawn about accuracy of Mobile Terrestrial Laser Scanning (MTLS) systems. The resulting Manual chapter, located in the appendix, defines standards and procedures for preparing, collecting, editing, delivering, exploiting, and archiving electronic mapping data that is created for Indiana Department of Transportation (INDOT). The purpose of the standards and procedures within this manual is to obtain statewide uniformity within the INDOT combined Aerial/Ground Survey process, to establish and maintain MTLS Standards for INDOT and contracted consultants, and allow for all of the project data to be effectively managed from conception to completion. These standards apply to all projects delivered to INDOT by contracted consulting firms, or exchanged internally within INDOT or between state agencies. The standards and procedures are the result of mobile terrestrial laser scanning surveys of two test sites - one urban and one freeway - created for this project. After establishing reference control points on the sites, each site was surveyed by four mobile terrestrial laser scanning vendors. The results from the vendor data over the test sites, in addition to information in published literature, are the basis for the specifications manual. The proposed chapter for the Survey Manual is in Appendix E of this report

A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence

Background: School gardening programmes are increasingly popular, with suggested benefits including healthier eating and increased physical activity. Our objectives were to understand the health and well-being impacts of school gardens and the factors that help or hinder their success. Methods: We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181). We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative evidence used to produce a conceptual framework to illustrate how benefits might be accrued. Results: Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on volunteers were thought to threaten success, while involvement with local communities and integration of gardening activities into the school curriculum were thought to support success. Conclusion: More robust quantitative research is needed to convincingly support the qualitative evidence suggesting wide ranging benefits from school gardens

Trends in Real Food Prices in Six Sub-Saharan African Countries

Demand and Price Analysis, Downloads July 2008-July 2009: 12,

Dietary interventions for recurrent abdominal pain in childhood

This is the final version of the article. Available from Wiley via the DOI in this record.BACKGROUND: This is an update of the original Cochrane review, last published in 2009 (Huertas-Ceballos 2009). Recurrent abdominal pain (RAP), including children with irritable bowel syndrome, is a common problem affecting between 4% and 25% of school-aged children. For the majority of such children, no organic cause for their pain can be found on physical examination or investigation. Many dietary inventions have been suggested to improve the symptoms of RAP. These may involve either excluding ingredients from the diet or adding supplements such as fibre or probiotics. OBJECTIVES: To examine the effectiveness of dietary interventions in improving pain in children of school age with RAP. SEARCH METHODS: We searched CENTRAL, Ovid MEDLINE, Embase, eight other databases, and two trials registers, together with reference checking, citation searching and contact with study authors, in June 2016. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing dietary interventions with placebo or no treatment in children aged five to 18 years with RAP or an abdominal pain-related, functional gastrointestinal disorder, as defined by the Rome III criteria (Rasquin 2006). DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We grouped dietary interventions together by category for analysis. We contacted study authors to ask for missing information and clarification, when needed. We assessed the quality of the evidence for each outcome using the GRADE approach. MAIN RESULTS: We included 19 RCTs, reported in 27 papers with a total of 1453 participants. Fifteen of these studies were not included in the previous review. All 19 RCTs had follow-up ranging from one to five months. Participants were aged between four and 18 years from eight different countries and were recruited largely from paediatric gastroenterology clinics. The mean age at recruitment ranged from 6.3 years to 13.1 years. Girls outnumbered boys in most trials. Fourteen trials recruited children with a diagnosis under the broad umbrella of RAP or functional gastrointestinal disorders; five trials specifically recruited only children with irritable bowel syndrome. The studies fell into four categories: trials of probiotic-based interventions (13 studies), trials of fibre-based interventions (four studies), trials of low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets (one study), and trials of fructose-restricted diets (one study).We found that children treated with probiotics reported a greater reduction in pain frequency at zero to three months postintervention than those given placebo (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.98 to -0.12; 6 trials; 523 children). There was also a decrease in pain intensity in the intervention group at the same time point (SMD -0.50, 95% CI -0.85 to -0.15; 7 studies; 575 children). However, we judged the evidence for these outcomes to be of low quality using GRADE due to an unclear risk of bias from incomplete outcome data and significant heterogeneity.We found that children treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (odds ratio (OR) 1.63, 95% CI 1.07 to 2.47; 7 studies; 722 children). The estimated number needed to treat for an additional beneficial outcome (NNTB) was eight, meaning that eight children would need to receive probiotics for one to experience improvement in pain in this timescale. We judged the evidence for this outcome to be of moderate quality due to significant heterogeneity.Children with a symptom profile defined as irritable bowel syndrome treated with probiotics were more likely to experience improvement in pain at zero to three months postintervention than those given placebo (OR 3.01, 95% CI 1.77 to 5.13; 4 studies; 344 children). Children treated with probiotics were more likely to experience improvement in pain at three to six months postintervention compared to those receiving placebo (OR 1.94, 95% CI 1.10 to 3.43; 2 studies; 224 children). We judged the evidence for these two outcomes to be of moderate quality due to small numbers of participants included in the studies.We found that children treated with fibre-based interventions were not more likely to experience an improvement in pain at zero to three months postintervention than children given placebo (OR 1.83, 95% CI 0.92 to 3.65; 2 studies; 136 children). There was also no reduction in pain intensity compared to placebo at the same time point (SMD -1.24, 95% CI -3.41 to 0.94; 2 studies; 135 children). We judged the evidence for these outcomes to be of low quality due to an unclear risk of bias, imprecision, and significant heterogeneity.We found only one study of low FODMAP diets and only one trial of fructose-restricted diets, meaning no pooled analyses were possible.We were unable to perform any meta-analyses for the secondary outcomes of school performance, social or psychological functioning, or quality of daily life, as not enough studies included these outcomes or used comparable measures to assess them.With the exception of one study, all studies reported monitoring children for adverse events; no major adverse events were reported. AUTHORS' CONCLUSIONS: Overall, we found moderate- to low-quality evidence suggesting that probiotics may be effective in improving pain in children with RAP. Clinicians may therefore consider probiotic interventions as part of a holistic management strategy. However, further trials are needed to examine longer-term outcomes and to improve confidence in estimating the size of the effect, as well as to determine the optimal strain and dosage. Future research should also explore the effectiveness of probiotics in children with different symptom profiles, such as those with irritable bowel syndrome.We found only a small number of trials of fibre-based interventions, with overall low-quality evidence for the outcomes. There was therefore no convincing evidence that fibre-based interventions improve pain in children with RAP. Further high-quality RCTs of fibre supplements involving larger numbers of participants are required. Future trials of low FODMAP diets and other dietary interventions are also required to facilitate evidence-based recommendations