Intravenous Acetaminophen Reduces Opioid Use for Postoperative Pain in Obese Patients Undergoing Laparoscopic Cholecystectomy

Opioid-induced respiratory depression is categorized as a sentinel event, which is an unanticipated occurrence that may result in severe injury or death. Although the incidence of opioid-induced respiratory depression is 0.2 to 2%, this issue persists as a substantial basis of morbidity and mortality. The obese population has multiple physiologic elements that increase their risk for opioid-induced respiratory depression. This retrospective study examined if intravenous (IV) acetaminophen reduces opioid consumption in the postoperative period in obese patients who underwent a laparoscopic cholecystectomy. Adequately controlled postoperative pain provides for greater patient satisfaction, decreased hospital length of stay (LOS), and reduced costs for the medical facility. The inclusion criterion comprised patients within the ages of 18 to 65, a body mass index (BMI) greater than 30, and who underwent a laparoscopic cholecystectomy at the designated medical facility. Exclusion criteria included patients with a known allergy to acetaminophen; severe hepatic impairment, chronic alcoholism or use of opioids, and malnutrition; severe hypovolemia, or renal impairment. The independent group t-test was used to compare the (a) amount of opioids administered in the post anesthesia care unit (PACU), (b) amount of opioids administered for the entire LOS, and (c) LOS between the two groups. There was a significant difference found in all of these factors. A considerable finding of this capstone project was the mean cost for patients who received IV acetaminophen was $1,143.60, compared to$1,406.00 for those who did not receive IV acetaminophen. This price difference was due to the variance in the total LOS

MIDDLE SCHOOL TEACHERS PERCEPTIONS OF THE FACTORS THAT SUPPORT OR IMPEDE THE INCLUSION OF READING STRATEGIES INTO CLASSROOM INSTRUCTION

This interpretive case study took place in an urban middle school where content area math and science teachers engaged in content area reading instruction designed to promote students reading development in their content area classes. Participants included eight teachers across grade levels six, seven and eight. Teachers participated in a Background Information Questionnaire designed to obtain their perceptions, literacy beliefs and literacy practices; focus group interviews created to explore their perceptions related to the key themes in the literature regarding content area reading instruction; structured one-on-one interviews to corroborate researcher interpretations of the initial data analysis and to collect individual teacher data on key themes created in focus group interviews; and finally, member checking sessions designed to verify key findings. ArrayKey findings revealed that these teachers held content area reading instruction within their content area class and felt responsible for students literacy learning while also being responsible for teaching content area standards. Students abilities emerged as a major theme regarding perceived impacts on students efforts to comprehend content area texts and vocabulary. Factors that teachers perceived as most supportive in teaching content area reading included instructional factors (teacher motivation and student motivation) and infrastructural factors (support from the administrative team, collaboration with English Language Arts colleagues, district literacy support and buy-in from all staff). Teacher-perceived obstacles to providing effective reading instruction included instructional factors (lack of instructional differentiated resources, excessive testing and student ability) and infrastructural factors (lack of adequate time, lack of proper undergraduate training, inadequate district professional development and student ability). Implications for schools and districts, as well as possibilities for future research were discussed

A study of polymers containing silicon- nitrogen bonds progress report, nov. 4 - dec. 3, 1964

Polymers containing silicon-nitrogen bonds as liquid and plastic materials in space and aviation technolog

Alleghanian Deformation and Metamorphism of Southern Narragansett Basin

Guidebook to geologic field studies in Rhode Island and adjacent areas: The 73rd annual meeting of the New England Intercollegiate Geological Conference, October 16-18, 1981: Trip C-

Wagon-Based Silage Yield Mapping System

Rosana G. Moreira, Editor-in-Chief; Texas A&M UniversityThis is a paper from International Commission of Agricultural Engineering (CIGR, Commission Internationale du Genie Rural) E-Journal Volume 7 (2005): Wagon-Based Silage Yield Mapping System by W. S. Lee, J. K. Schueller, T. F. Burk

Ground motion selection for simulation-based seismic hazard and structural reliability assessment

This paper examines four methods by which ground motions can be selected for dynamic seismic response analyses of engineered systems when the underlying seismic hazard is quantified via ground motion simulation rather than empirical ground motion prediction equations. Even with simulation-based seismic hazard, a ground motion selection process is still required in order to extract a small number of time series from the much larger set developed as part of the hazard calculation. Four specific methods are presented for ground motion selection from simulation-based seismic hazard analyses, and pros and cons of each are discussed via a simple and reproducible illustrative example. One of the four methods (method 1 ‘direct analysis’) provides a ‘benchmark’ result (i.e. using all simulated ground motions), enabling the consistency of the other three more efficient selection methods to be addressed. Method 2 (‘stratified sampling’) is a relatively simple way to achieve a significant reduction in the number of ground motions required through selecting subsets of ground motions binned based on an intensity measure, IM. Method 3 (‘simple multiple stripes’) has the benefit of being consistent with conventional seismic assessment practice using as-recorded ground motions, but both methods 2 and 3 are strongly dependent on the efficiency of the conditioning IM to predict the seismic responses of interest. Method 4 (‘GCIM-based selection’) is consistent with ‘advanced’ selection methods used for as-recorded ground motions, and selects subsets of ground motions based on multiple IMs, thus overcoming this limitation in methods 2 and 3

Peirce's evolutionary pragmatic idealism

In this paper I synthesize a unified system out of Peirce's life work, and name it “Peirce's Evolutionary Pragmatic Idealism”. Peirce developed this philosophy in four stages: (I) His 1868–69 theory that cognition is a continuous and infinite social semiotic process, in which Man is a sign.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43816/1/11229_2004_Article_BF00413590.pd

Geographic Variation in Agonistic Responses of Territorial Male Brook Sticklebacks, Culae Inconstans

Author Institution: Department of Biology, Wilmington College ; Department of Biology, Earlham CollegeTerritorial aggressive behavior was studied in male brook sticklebacks collected in Saskatoon, Saskatchewan; Oshkosh, Wisconsin; Ft. Atkinson, Wisconsin, and Urbana, Ohio. In the 20 h of observation 1,167 individual encounters with 3,305 separate aggressive displays were observed. Aggressive behavior was observed to be complex with at least 12 distinct aggressive display postures observed