Benefits of Palliative Care in the Intensive Care Unit

Abstract The use of palliative care is often overlooked until the terminal phase of serious illness when life-prolonging interventions are deemed futile and death is considered imminent. Alongside the well regarded Clinical Practice Guidelines for Quality Palliative Care (National Coalition for Hospice and Palliative Care, 2018), numerous critical care societies including the American Association of Critical-Care Nurses (Medina & Puntillo, 2006), American College of Critical Care Medicine (Davidson et al., 2008), American College of Chest Physicians (Selecky et al., 2005), American College of Surgeons (2017), and the American Thoracic Society (Lanken et al., 2007) have each published individual policies highlighting the importance Palliative Care medicine in the intensive care unit. The most recent joint policy statement from the Choosing Wisely (2014) task force comprised of the aforementioned critical care societies that addresses palliative care recommends regular engagement in conversations regarding comfort alternatives with families and patients at a high risk of death. Based on the outcomes of a systematic literature review and review of multiple clinical policy guidelines, the recommendation is to consider a piloted evidence-based practice project that explores the timely assessment of critically ill patients with the use of a palliative care bundled approach to screening patients meeting criteria for palliative care services. Providing timely and consistent palliative care services has been found to provide several benefits including improved symptom management, increased quality of life, increased patient and family satisfaction, decreased Intensive Care Unit and hospital length of stay, a decrease in downstream hospital costs, and readmission rates (Braus et al., 2017; Ciemins, Blum, Nunley, Lasher, & Newman, 2007; Kupensky, Hileman, Emerick, & Chance, 2015; Weissman & Meier, 2011

The effect of social skills training for elementary students with learning disabilities

The purpose of this study was to examine the effectiveness of the social skills program Skillstreaming the Elementary School Child for elementary children with learning disabilities. Two first grade and two second grade students participated in the study. All students were classified as specific learning disabled and were included in the general education classroom with instructional support from a resource room. The intervention consisted of 12 sessions, using the Skillstreaming program 20 minutes per day, four days a week for 3 weeks, and weekly follow-up of review for 4 weeks with a total of 7 weeks. A multiple baseline design across participating students was used in the study. The children\u27s behaviors were observed and recorded in three phases; A, Baseline, B, Intervention and C, Follow-up. The results of the study showed an increase of appropriate behaviors such as ignoring distractions, listening and contributing to discussion during phase B, but a decrease during the follow-up phase. Future research is needed to validate the findings to further examine this Skillstreaming program for primary elementary students

Potential Regional Bias in Radar Detected Tornadogenesis

This research studied differential reflectivity (ZDR) in pre- and non-tornadic supercells to determine if a regional bias occurred in the previously found suggested signal in the hook echo region. The previous study focused on the central plains and, with a 95% confidence level, found that the mean ZDR values in pre-tornadic supercells was lower than that of non-tornadic. A new region of study was selected and statistical analysis was performed on pre- and non-tornadic supercells in this new region. The same relationship for ZDR between pre- and non-tornadic supercells was observed in the new region with pre-torndic mean was lower than non-tornadic in the hook echo region. However: due to the small number of cases between both regions and the presence of other regions that tornadic supercells occur, a lack of regional bias in the ZDR relationship can be suggested but not proven. A regional bias in the average ZDR for the cases may have been found but further testing is required. A confirmation of the relationship between ZDR and tornadogenisis also cannot be proven but can be suggested in two regions

Plasma Diagnostics by Antenna Impedance Measurements

The impedance of an electrically short antenna immersed in a plasma provides an excellent in situ diagnostic tool for electron density and other plasma parameters. By electrically short we mean that the wavelength of the free-space electromagnetic wave that would be excited at the driving frequency is much longer than the physical size of the antenna. Probes using this impedance technique have had a long history with sounding rockets and satellites, stretching back to the early 1960s. This active technique could provide information on composition and temperature of plasmas for comet or planetary missions. Advantages of the impedance probe technique are discussed and two classes of instruments built and flown by SDL-USU for determining electron density (the capacitance and plasma frequency probes) are described

GRB Flares: UV/Optical Flaring (Paper I)

We present a new algorithm for the detection of flares in gamma-ray burst (GRB) light curves and use this algorithm to detect flares in the UV/optical. The algorithm makes use of the Bayesian Information Criterion (BIC) to analyze the residuals of the fitted light curve, removing all major features, and to determine the statistically best fit to the data by iteratively adding additional `breaks' to the light curve. These additional breaks represent the individual components of the detected flares: T_start, T_stop, and T_peak. We present the detection of 119 unique flaring periods detected by applying this algorithm to light curves taken from the Second Swift Ultraviolet/Optical Telescope (UVOT) GRB Afterglow Catalog. We analyzed 201 UVOT GRB light curves and found episodes of flaring in 68 of the light curves. For those light curves with flares, we find an average number of ~2 flares per GRB. Flaring is generally restricted to the first 1000 seconds of the afterglow, but can be observed and detected beyond 10^5 seconds. More than 80% of the flares detected are short in duration with Delta t/t of < 0.5. Flares were observed with flux ratios relative to the underlying light curve of between 0.04 to 55.42. Many of the strongest flares were also seen at greater than 1000 seconds after the burst.Comment: Submitted to ApJ. 20 pages (including 8 figures and 1 table

The collective gyration of a heavy ion cloud in a magnetized plasma

In both the ionospheric barium injection experiments CRIT 1 and CRIT 2, a long duration oscillation was seen with a frequency close to the gyro frequency of barium and a time duration of about one second. A model for the phenomena which was proposed for the CRIT 1 experiment is compared to the results from CRIT 2 which made a much more complete set of measurements. The model follows the motion of a low Beta ion cloud through a larger ambient plasma. The internal field of the model is close to antiparallel to the injection direction v sub i but slightly tilted towards the self polarization direction E sub p = -V sub i by B. As the ions move across the magnetic field, the space charge is continuously neutralized by magnetic field aligned electron currents from the ambient ionosphere, drawn by the divergence in the perpendicular electric field. These currents give a perturbation of the magnetic field related to the electric field perturbation by Delta E/Delta B approximately equal to V sub A. The model predictions agree quite well with the observed vector directions, field strengths, and decay times of the electric and magnetic fields in CRIT 2. The possibility to extend the model to the active region, where the ions are produces in this type of self-ionizing injection experiments, is discussed

Legal Pluralism and Women's Rights after Conflict: The Role of CEDAW

Protecting and promoting women’s rights is an immense challenge after conflict, especially when the capacity of the state’s legal system is limited and non - state justice systems handle most disputes. However, legal pluralism’s implications for gender equality remain under-theorized, as is CEDAW’s potential to improve women’s rights in these settings. This Article offers a theoretical framework to help understand the varying relationships between state and non-state justice. It also proposes strategies for interacting with different types of legal pluralisms that will allow the CEDAW Committee to more effectively promote gender equality in legally pluralistic, post-conflict states, as is illuminated in case studies from Afghanistan and Timor-Leste

Observations of Triboelectric Charging Effects on Langmuir-Type Probes in Dusty Plasma

Investigation of Earth’s mesosphere using sounding rockets equipped with a myriad of instruments has been a highly active field in the last 2 decades. This paper presents data from three separate instruments: an RF impedance probe, a DC fixed bias Langmuir probe, and an electric field probe, that were flown on a mesospheric sounding rocket flight investigating the presence of charged dust within and/or around a sporadic metal layer. The combined data set indicates a case of payload surface charging, the causes of which are investigated within this paper. A generic circuit model is developed to analyze payload charging and behavior of Langmuir-type instruments. The application of this model to the rocket payload indicates that the anomalous charging event was an outcome of triboelectrification of the payload surface from neutral dust particles present in the Earth’s mesosphere. These results suggest caution in interpreting observations from the Langmuir class of instrumentation within dusty environment