Adherence to the ICU Liberation ABCDEF Bundle Improves Patient Outcomes in the ICU

Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework for analysis of the organization\u27s planning and implementation of this quality improvement project. Benchmark data from an organization\u27s participation in the ICU Liberation Collaborative served as the primary source of evidence for analysis of outcomes. In addition, baseline data on current practice and outcomes in the organization\u27s trauma ICU was analyzed and compared to the benchmark data. Analyses of data revealed strengths and opportunities for improvement in both the organization\u27s project management and in current practices supporting adherence to the ABCDEF bundle guidelines. Incidence of delirium remained unchanged and far below national averages indicating need for further investigation into practices to verify this finding. Better prevention, identification, and management of delirium will lead to a positive impact on society, as patients who develop delirium rarely return to their baseline level of functioning

Mind The Gap: Preparing For The Future Leaders Of Small Private Colleges In New England

At a time when the higher education as a whole is experiencing an incredible leadership turnover and a narrowing pipeline of prepared or willing leaders to step into these important roles, the industry is also experiencing more scrutiny than ever before, creating a challenging time for the leaders of these institutions. Small private colleges in New England, in particular, have their own unique set of complications, which makes finding the right kind of future leaders particularly important. This phenomenological study explored the lived experiences of 14 small private college presidents amidst an incredibly unique set of factors which substantially complicate the roles for leaders of small, private institutions in New England with modest endowments. The study found two primary roles that the presidents must fulfill: a Leadership Paradox of communication strategies and a Leader/Follower responsibility to its Board. Finally, the emotional consequence of fulfilling these two roles is explained in the Treading Water in a Changing Tide theme. This study fills a gap in the literature related to this specific niche of the industry, at a time when leadership succession and the future of small private colleges is an important conversation for the future of higher education

Identification of sleep apnea events using discrete wavelet transform of respiration, ECG and accelerometer signals

Sleep apnea is a common sleep disorder in which patient sleep patterns are disrupted due to recurrent pauses in breathing or by instances of abnormally low breathing. Current gold standard tests for the detection of apnea events are costly and have the addition of long waiting times. This paper investigates the use of cheap and easy to use sensors for the identification of sleep apnea events. Combinations of respiration, electrocardiography (ECG) and acceleration signals were analysed. Results show that using features, formed using the discrete wavelet transform (DWT), from the ECG and acceleration signals provided the highest classification accuracy, with an F1 score of 0.914. However, the novel employment of just the accelerometer signal during classification provided a comparable F1 score of 0.879. By employing one or a combination of the analysed sensors a preliminary test for sleep apnea, prior to the requirement for gold standard testing, can be performed

Microbial Volatile Organic Compounds Associated with Decomposition Mediate Foraging Behavior of the Red Imported Fire Ant (Solenopsis invicta Buren) (Hymenoptera: Formicidae)

Examining the chemicals involved in interkingdom interactions (e.g., microbe-insect) is useful for understanding the mechanisms governing insect behavior. Recent studies have shown that blow flies (Diptera: Calliphoridae) involved in carrion decomposition are attracted to concentrations of volatile chemical signals emitted by swarming bacterial strains such as Proteus mirabilis (Enterobacteriales: Enterobacteriaceae). This research presents field and laboratory responses of the red imported fire ant Solenopsis invicta Buren (Hymenoptera: Formicidae) (RIFA) to baits with VOCs associated with P. mirabilis to determine dose dependent responses that may be useful for understanding interkingdom interactions and potential applications in forensic entomology and urban pest control. Field trials took place in two environments in College Station, TX, USA: an agricultural enclosure (rural) and a manicured lawn (urban). Responses to baits treated with one of four compounds diluted to one of two different concentrations were site specific. In the urban environment, indole (IND) at 5.0 μg concentration displayed the highest RIFA attraction to baits at 15% overall; 34% more than the control. Dimethyl disulfide (DMDS) at 0.005 μg concentration displayed the least attraction at 6%; 45% less than the control. In the rural environment, phenylacetic acid (PAA) at 0.1 μg concentration and dimethyl disulfide at 0.25 μg concentration displayed the highest attraction of RIFA response to baits with 17.7% and 17.3% overall attraction; 148% and 142% more than the control bait, respectively. Isobutylamine (IBA) at 0.01 μg concentration displayed the least attraction with 3.5% overall attraction to bait; 50% less attractive than the control. Laboratory choice assays were conducted to validate results from fieldwork. Following three trials, RIFA attraction to a compound concentration compared to controls of either plain bait or bait with acetone were variable for RIFA attracted to a bait and amount of bait removed. However, IND 0.05 μg and DMDS at both high and low concentrations were the most attractive of the compounds compared to controls. Like other insects, RIFA respond differently to compounds depending on concentration and environment. Microbial communities may have a significant impact on motivating generalist species to select one resource over another, leading to better pest management strategies

Variation in the flowering time orthologs BrFLC and BrSOC1 in a natural population of Brassica rapa.

Understanding the genetic basis of natural phenotypic variation is of great importance, particularly since selection can act on this variation to cause evolution. We examined expression and allelic variation in candidate flowering time loci in Brassica rapa plants derived from a natural population and showing a broad range in the timing of first flowering. The loci of interest were orthologs of the Arabidopsis genes FLC and SOC1 (BrFLC and BrSOC1, respectively), which in Arabidopsis play a central role in the flowering time regulatory network, with FLC repressing and SOC1 promoting flowering. In B. rapa, there are four copies of FLC and three of SOC1. Plants were grown in controlled conditions in the lab. Comparisons were made between plants that flowered the earliest and latest, with the difference in average flowering time between these groups ∼30 days. As expected, we found that total expression of BrSOC1 paralogs was significantly greater in early than in late flowering plants. Paralog-specific primers showed that expression was greater in early flowering plants in the BrSOC1 paralogs Br004928, Br00393 and Br009324, although the difference was not significant in Br009324. Thus expression of at least 2 of the 3 BrSOC1 orthologs is consistent with their predicted role in flowering time in this natural population. Sequences of the promoter regions of the BrSOC1 orthologs were variable, but there was no association between allelic variation at these loci and flowering time variation. For the BrFLC orthologs, expression varied over time, but did not differ between the early and late flowering plants. The coding regions, promoter regions and introns of these genes were generally invariant. Thus the BrFLC orthologs do not appear to influence flowering time in this population. Overall, the results suggest that even for a trait like flowering time that is controlled by a very well described genetic regulatory network, understanding the underlying genetic basis of natural variation in such a quantitative trait is challenging

A Safety Net for Social Networking: Development of a Predictive Tool for Domestic Terrorism

There is a growing trend of disturbed individuals expressing their unhappiness with elements of government or society in general by committing violent acts. In a high number of these cases, the perpetrators gave clues through social networks as to what they planned to do beforehand. While technology can identify certain key words and phrases, it has not advanced to the point of being able to quickly discern between trivial and non-trivial threats. This paper describes ongoing research into developing a tool that can assist in the prediction of terroristic behavior using data from social networks combined with personal knowledge of the individual

Functional muscle hypertrophy by increased insulin-like growth factor 1 does not require dysferlin.

IntroductionDysferlin loss-of-function mutations cause muscular dystrophy, accompanied by impaired membrane repair and muscle weakness. Growth promoting strategies including insulin-like growth factor 1 (IGF-1) could provide benefit but may cause strength loss or be ineffective. The objective of this study was to determine whether locally increased IGF-1 promotes functional muscle hypertrophy in dysferlin-null (Dysf-/- ) mice.MethodsMuscle-specific transgenic expression and postnatal viral delivery of Igf1 were used in Dysf-/- and control mice. Increased IGF-1 levels were confirmed by enzyme-linked immunosorbent assay. Testing for skeletal muscle mass and function was performed in male and female mice.ResultsMuscle hypertrophy occurred in response to increased IGF-1 in mice with and without dysferlin. Male mice showed a more robust response compared with females. Increased IGF-1 did not cause loss of force per cross-sectional area in Dysf-/- muscles.DiscussionWe conclude that increased local IGF-1 promotes functional hypertrophy when dysferlin is absent and reestablishes IGF-1 as a potential therapeutic for dysferlinopathies

Top-down control of visual sensory processing during an ocular motor response inhibition task

The study addressed whether top-down control of visual cortex supports volitional behavioral control in a novel antisaccade task. The hypothesis was that anticipatory modulations of visual cortex activity would differentiate trials on which subjects knew an anti- versus a pro-saccade response was required. Trials consisted of flickering checkerboards in both peripheral visual fields, followed by brightening of one checkerboard (target) while both kept flickering. Neural activation related to checkerboards before target onset (bias signal) was assessed using electroencephalography. Pretarget visual cortex responses to checkerboards were strongly modulated by task demands (significantly lower on antisaccade trials), an effect that may reduce the predisposition to saccade generation instigated by visual capture. The results illustrate how top-down sensory regulation can complement motor preparation to facilitate adaptive voluntary behavioral control