Diabetic Ketoacidosis (DKA) Insulin Infusion Protocol Update Using Evidence-Based Practice: A Quality Improvement Project

Diabetic Ketoacidosis is a life-threatening side effect to Diabetes Mellitus. Standards of treatment and recommendations are made by the American Diabetes Association. The project was to evaluate and provide the latest evidence-based practice to update the hospital policy for the treatment of DKA in the Intensive Care Unit and Emergency Department. Retrospective chart reviews were conducted to review the number of patients admitted with diabetic ketoacidosis and treated on the DKA Insulin Infusion Protocol before and after the update. Rapid correction of blood glucose levels proved to be an issue at this facility both before and after the updates were made to the DKA Insulin Infusion Protocol. The data supports the need for change in protocol, staff development in the use of the protocol and the need for change in the emergency department as well as the intensive care unit

Factors Affecting Posterior Capsule Opacification in the Development of Intraocular Lens Materials

Posterior capsule opacification (PCO) is the most common complication arising from the corrective surgery used to treat cataract patients. PCO arises when lens epithelial cells (LEC) residing in the capsular bag post-surgery undergo hyper-proliferation and transdifferentiation into myofibroblasts, migrating from the posterior capsule over the visual axis of the newly implanted intraocular lens (IOL). The developmental pathways underlying PCO are yet to be fully understood and the current literature is contradictory regarding the impact of the recognised risk factors of PCO. The aim of this review is firstly to collate the known biochemical pathways that lead to PCO development, providing an up-to-date chronological overview from surgery to established PCO formation. Secondly, the risk factors of PCO are evaluated, focussing on the impact of IOLs’ properties. Finally, the latest experimental model designs used in PCO research are discussed to demonstrate the ongoing development of clinical PCO models, the efficacy of newly developed IOL technology, and potential therapeutic interventions. This review will contribute to current PCO literature by presenting an updated overview of the known developmental pathways of PCO, an evaluation of the impact of the risk factors underlying its development, and the latest experimental models used to investigate PCO. Furthermore, the review should provide developmental routes for research into the investigation of potential therapeutic interventions and improvements in IOL design in the aid of preventing PCO for new and existing patients

Self-selecting peer groups formed within the laboratory environment have a lasting effect on individual student attainment and working practices.

Within the present study, we investigate the lasting effect of laboratory peer group interactions on the end of year attainment of bioscience and chemistry students. By asking students to identify who they primarily work with within the laboratory environment and evaluating the interactions through cluster analysis, we identified two main categories of laboratory peer groups. The first long-lived well-established pairings of two students, "swans", who work together for all or the majority of the laboratory sessions and the second dynamic fluid groups, "dolphins", of between three to nine students who work with each other interchangeably. Statistical analysis is presented, which demonstrates that individuals within each lab peer group were likely to achieve a similar average mark at the end of the first year of study on the course. We identified the driving factors for the formation of these groups as friendship and perceived work ethic. There is a preference for high achieving students to work with other high achieving students and lower-achieving to group around a shared social background. Targeted interventions, in which pairings were selected by the tutor at the onset of the study, altered the ratio from long-lived pairs to more dynamic groups and increased students willingness to work with others outside of their group but did not change the drivers of group formation or resulting pattern of achievement. We conclude with recommendations around group working within the laboratory environment

The incidence and make up of ability grouped sets in the UK primary school

The adoption of setting in the primary school (pupils ability grouped across classes for particular subjects) emerged during the 1990s as a means to raise standards. Recent research based on 8875 children in the Millennium Cohort Study showed that 25.8% of children in Year 2 were set for literacy and mathematics and a further 11.2% of children were set for mathematics or literacy alone. Logistic regression analysis showed that the best predictors of being in the top set for literacy or mathematics were whether the child was born in the Autumn or Winter and cognitive ability scores. Boys were significantly more likely than girls to be in the bottom literacy set. Family circumstances held less importance for setting placement compared with the child’s own characteristics, although they were more important in relation to bottom set placement. Children in bottom sets were significantly more likely to be part of a long-term single parent household, have experienced poverty, and not to have a mother with qualifications at NVQ3 or higher levels. The findings are discussed in relation to earlier research and the implications for schools are set out

A case study of the patient wait experience in an emergency department with therapy dogs

The quality of patient healthcare is a growing concern in Canada’s hospital emergency departments (ED) due to increasing wait times and associated adverse outcomes. A developing body of literature indicates that therapy dogs can positively impact the patient experience. In 2016, members of our team partnered with the Royal University Hospital (RUH) in Saskatchewan to become the first ED in Canada to integrate a visiting therapy dog to positively impact the patient wait experience. The aim of this preliminary case study was to examine if and how this unique initiative impacted patients’ feelings during their ED wait. A brief questionnaire was completed with one-hundred and twenty-four patients pre and post-therapy dog visit and a research observer documented the encounters. Quantitative and qualitative analysis of the data revealed that visiting with a therapy dog in the ED appeared to improve patients’ feelings. Specifically, patients’ perceived comfort levels increased and their distress levels decreased, and the encounters were considered by patients to be a welcome distraction from the stressful ED environment. Our team, comprised of clinicians, researchers, therapy dog handlers and patient advocates documented the advantages and challenges of implementing the initiative. The outcomes support further study of patients’ wait time experiences in the ED and the utility of a visiting therapy dog

Air pollution-related health and climate benefits of clean cookstove programs in Mozambique

Approximately 95% of households in Mozambique burn solid fuels for cooking, contributing to elevated indoor and outdoor fine particulate matter (PM2.5) concentrations and subsequent health and climate impacts. Little is known about the potential health and climate benefits of various approaches for expanding the use of cleaner stoves and fuels in Mozambique. We use state-of-thescience methods to provide a first-order estimation of potential air pollution-related health and climate benefits of four illustrative scenarios in which traditional cooking fires and stoves are displaced by cleaner and more efficient technologies. For rural areas, we find that a 10% increase in the number of households using forced draft wood-burning stoves could achieve >2.5 times more health benefits from reduced PM2.5 exposure (200 avoided premature deaths and 14 000 avoided disability adjusted life years, DALYs, over a three-year project lifetime) compared to natural draft stoves in the same households, assuming 70% of households use the new technology for both cases. Expanding use of LPG stoves to 10% of households in five major cities is estimated to avoid 160 premature deaths and 11 000 DALYs from reduced PM2.5 exposure for a three-year intervention, assuming 60% of households use the new stove. Advanced charcoal stoves would achieve ∽80% of the PM2.5-related health benefits of LPG stoves. Approximately 2%–5% additional health benefits would result from reduced ambient PM2.5, depending on the scenario. Although climate impacts are uncertain, we estimate that all scenarios would reduce expected climate change-related temperature increases from continued solid fuel use by 4%–6% over the next century. All results are based on an assumed adjustment factor of 0.8 to convert from laboratory-based emission reduction measurements to exposure reductions, which could be optimistic in reality given potential for continued use of the traditional stove. We conclude that cleaner cooking stoves in Mozambique can achieve health and climate benefits, though both are uncertain and local information about baseline and intervention PM2.5 exposure levels are needed

Secondary school pupils' preferences for different types of structured grouping practices

The aim of this paper is to explore pupils’ preferences for particular types of grouping practices an area neglected in earlier research focusing on the personal and social outcomes of ability grouping. The sample comprised over 5,000 year 9 pupils (aged 13-14 years) in 45 mixed secondary comprehensive schools in England. The schools represented three levels of ability grouping in the lower school (years 7 to 9). Pupils responded to a questionnaire which explored the types of grouping that they preferred and the reasons for their choices. The majority of pupils preferred setting, although this was mediated by their set placement, type of school, socio-economic status and gender. The key reason given for this preference was that it enabled work to be matched to learning needs. The paper considers whether there are other ways of achieving this avoiding the negative social and personal outcomes of setting for some pupils

Targeted suppression of autoreactive CD8+ T-cell activation using blocking anti-CD8 antibodies

CD8+ T-cells play a role in the pathogenesis of autoimmune diseases such as multiple sclerosis and type 1 diabetes. However, drugs that target the entire CD8+ T-cell population are not desirable because the associated lack of speci city can lead to unwanted consequences, most notably an enhanced susceptibility to infection. Here, we show that autoreactive CD8+ T-cells are highly dependent on CD8 for ligand-induced activation via the T-cell receptor (TCR). In contrast, pathogen-speci c CD8+ T-cells are relatively CD8-independent. These generic di erences relate to an intrinsic dichotomy that segregates self-derived and exogenous antigen-speci c TCRs according to the monomeric interaction a nity with cognate peptide-major histocompatibility complex class I (pMHCI). As a consequence, “blocking” anti-CD8 antibodies can suppress autoreactive CD8+ T-cell activation in a relatively selective manner. These ndings provide a rational basis for the development and in vivo assessment of novel therapeutic strategies that preferentially target disease-relevant autoimmune responses within the CD8+ T-cell compartment