Troponin Elevation in Chronic Kidney Disease: An Educational Project

Many patients may present to Emergency Departments (ED) daily for a multitude of medical issues that may include chest pain, shortness of breath, nausea, vomiting, elevated troponin levels in the presence of CKD, abnormal serum BUN and creatinine levels, or an abnormal renal ultra sound. Troponin levels that are elevated within the presence of CKD with no other signs and symptoms is not concerning for ACS or MI, but for cardiovascular death and mortality. The purpose of this project was to develop, create and deliver an educational program designed to increase nursing knowledge of elevated troponin levels in the presence of Chronic Kidney Disease. A pre-&post-test design was developed and implemented to measure the nursing staff’s knowledge of elevated troponin levels in the presence of CKD. The educational program was designed as a pamphlet that provided information from the literature and relevant clinical experience about signs, symptoms and the diagnosis of CKD, signs & symptoms of Acute Coronary Syndrome, (ACS). Twenty-three nurses (25%) completed both the pretest with a mean score of 74.7% with total scores ranging from 40%-90%. Twenty-three nurses also (25%) also completed the post-test with a mean score of 76.5% with total scores that ranged from 50%-100% which helped to prove there was an overall increase in learning, therefore suggesting that nurses’ knowledge on the topic was improved. Recommendations and implications for APRNs are also discussed

Direct calorimetric measurements of isothermal entropy change on single crystal W-type hexaferrites at the spin reorientation transition

We report on the magnetic field induced isothermal entropy change, \Delta s(Ha, T), of W-type ferrite with CoZn substitution. Entropy measurements are performed by direct calorimetry. Single crystals of the composition BaCo$_0.62$Zn$_1.38$Fe$_16$O$_27$, prepared by the flux method, are measured at different fixed temperatures under an applied field perpendicular and parallel to the c axis. At 296 K one deduces a value of K$_1$ = 8.7 \times 10^{4} J m$^-3$ for the first anisotropy constant, which is in good agreement with the literature. The spin reorientation transition temperature is estimated to take place between 200 and 220 K

Sense of Belonging of New Members who are First-Generation College Students: A Single-Institution Qualitative Case Study

While there is research to suggest that first-generation college students benefit from and have a greater sense of belonging as a result of involvement in student organizations, there is limited research on how first-generation college students develop a sense of belonging specifically through their involvement as new members of a fraternity or sorority. This study, constructed within a single-institution qualitative case study framework, highlighted the unique role that organizational involvement, mentorship, emotional support, and first-generation status and identity can play in the development of sense of belonging for fraternity and sorority new members that are first-generation college students

Strutjet-powered reusable launch vehicles

Martin Marietta and Aerojet are co-investigating the feasibility and viability of reusable launch vehicle designs. We are assessing two vehicle concepts, each delivering 8000 lb to a geosynchronous transfer orbit (GTO). Both accomplish this task as a two-state system. The major difference between the two concepts is staging. The first concept, the two-stage-to-orbit (TSTO) system, stages at about 16 kft/sec, allowing immediate return of the first stage to the launch site using its airbreathing propulsion system for a powered cruise flight. The second concept, the single-stage-to-orit (SSTO) system, accomplishes stage separation in a stable low earth orbit (LEO)

How Managed Care Affects Medicaid Utilization: A Synthetic Difference-in-Differences Zero-Inflated Count Model

We develop a synthetic difference-in-differences statistical design to apply to experimental data for adult women living in Hennepin County, Minnesota, to estimate the impact of Medicaid managed care on various modes of medical care use. Because the outcomes of interest are utilization counts with many persons using none of a particular mode of care we use count regression models that are adjusted for excessive zeros. We find no reductions in physician visits or hospital inpatient and emergency department care use, but reductions in hospital outpatient care. Simulations designed to judge the economic significance of our results suggest a program effect that is a savings of about ten percent

Political Competition and Judicial Independence: How Courts Fill the Void When Legislatures Are Ineffective

What effect does political competition have in generating de facto judicial independence? We argue that competition in a legislature can drive increases in de facto judicial independence. Our game-theoretic model reveals that increased competition for seats impedes legislators’ ability to enact their platforms, regardless of government turnover probability, and increased legislative fractionalization also makes court intervention more likely. Utilizing a sample of democratic states, empirical evidence suggests when a country’s legislature is increasingly fractionalized among parties or has increasing seat turnover, we observe increases in de facto independence. This research provides new perspectives on the link between independence and competition

Experimental characterization and numerical modelling of the impact behavior of PVC foams

Background Polyvinyl chloride (PVC) foams are widely used in crashworthiness and energy absorption applications due to their low density and the capability of crushing up to large deformations with limited loads. This property is due to their particular constitutive behavior: the stress-strain curve is characterized, after an initial yield or peak stress, by a relevant plateau region followed by a steep increase due to foam densification. Furthermore, the mechanical response of PVC foam is strongly strain rate dependent. Objective This work aims to characterize the mechanical behavior of PVC foams and to develop a complete constitutive model for impact and energy absorption applications. Methods Compressive tests are carried out at different speeds on PVC foam samples having different relative densities. Quasi-static and intermediate strain rate tests are performed by a pneumatic machine, while high strain rate tests are conducted by means of a Split Hopkinson Pressure Bar. The uniaxial stress-strain curves are used to calibrate the visco-elastic and visco-plastic constitutive model. In particular, the material behavior is divided into two parallel branches: the former describes the elasto-plastic behavior, while the latter accounts for the visco-elastic one; the plastic branch also includes a multiplicative term accounting for the strain rate sensitivity of the base material. Results The tests highlight a strong compressibility of the foam with negligible lateral expansion. The energy absorption efficiency, as well as the densification strain, is evaluated. The material model is also implemented in Finite Element (FE) simulations of puncture impact tests, validating the results of the calibration procedure. Conclusions The calibration of the visco-elasto-plastic material model offers a physically consistent identification of the constitutive response of the PVC foams, showing an effective characterization of the impact behavior of the material

Influence of rotational force fields on the determination of the work done on a driven Brownian particle

For a Brownian system the evolution of thermodynamic quantities is a stochastic process. In particular, the work performed on a driven colloidal particle held in an optical trap changes for each realization of the experimental manipulation, even though the manipulation protocol remains unchanged. Nevertheless, the work distribution is governed by established laws. Here, we show how the measurement of the work distribution is influenced by the presence of rotational, i.e. nonconservative, radiation forces. Experiments on particles of different materials show that the rotational radiation forces, and therefore their effect on the work distributions, increase with the particle refractive index.Comment: 12 pages, 4 figure

Single-level degenerative cervical disc disease and driving disability: Results from a prospective, randomized trial

Study Design Post hoc analysis of prospective, randomized trial. Objective To investigate the disability associated with driving and single-level degenerative, cervical disc disease and to investigate the effect of surgery on driving disability. Methods Post hoc analysis of data obtained from three sites participating in a multicenter, randomized, controlled trial comparing cervical disc arthroplasty (TDA) with anterior cervical discectomy and fusion (ACDF). The driving subscale of the Neck Disability Index (NDI) was analyzed for all patients. A dichotomous severity score was created from the NDI. Statistical comparisons were made within and between groups. Results Two-year follow-up was available for 118/135 (87%) patients. One half of the study population (49.6%) reported moderate or severe preoperative driving difficulty. This disability associated with driving was similar among the two groups (ACDF: 2.5 ± 1.1, TDA: 2.6 ± 1.0, p = 0.646). The majority of patients showed improvement, with no or little driving disability, at the sixth postoperative week (ACDF: 75%, TDA: 90%, p = 0.073). At no follow-up point did a difference exist between groups according to the severity index. Conclusions Many patients suffering from radiculopathy or myelopathy from cervical disc disease are limited in their ability to operate an automobile. Following anterior cervical spine surgery, most patients are able to return to comfortable driving at 6 weeks