Stop the Bleed and Seize Control: The use of Simulation and Video Modules in Educating Emergency Department Staff Regarding Maternal Hypertension and Hemorrhage

In order to address shortcomings of the health care system within the United States surrounding the early recognition and response to preeclampsia (PreE) and postpartum hemorrhage (PPH) emergencies The Joint Commission (TJC) revised the accreditation requirements regarding implementing yearly maternal hypertension and hemorrhage simulation scenarios in emergency departments. A Quality improvement team of Clinical Nurse Leader (CNL) students at University of San Francisco, working alongside the emergency department and labor and delivery department nurse educators assisted a dual hospital system in the Bay Area of California to develop and implement training materials and simulations for the hospital system’s Emergency Department (ED) staff. Pre and post simulation data were collected, and simulation debriefs were conducted to determine staffs level of awareness of hospital policies and procedures as well as comfort levels in recognizing and treating PreE and PPH prior to and after implementation of the simulation scenarios. The CNL students were also tasked with developing a staged and recorded example of two simulations, PreE and PPH, to be uploaded to the hospital system’s knowledge center (online learning platform) in early 2023. Low survey response rates made results analysis difficult but the debriefs provided valuable insight into the usefulness of simulation and debrief to increase awareness of policies and procedures. The QI team and will not be able to obtain post-intervention data on the effectiveness of the video training materials until implementation in early 2023

Participación ciudadana para la construcción de culturas de Paz: una propuesta sobre Presupuestos Participativos

Treball final de Màster Universitari en Estudis internacionals de Pau, Conflictes i Desenvolupament. Codi: SBG120. Curs acadèmic 2016-2017En el presente documento se desarrolla la presentación del proyecto «Participación ciudadana para la Construcción de Culturas de Paz: una propuesta sobre Presupuestos Participativos», en el marco de la Unión Nacional de Estudiantes de Nicaragua – Sede Universidad Politécnica de Nicaragua [UNEN-UPOLI]. La iniciativa, que emerge en el contexto de la experiencia desarrollada en el Instituto Martin Luther King [MLK] con motivo de las prácticas realizadas entre Mayo y Julio de 2017. La misma se ha elaborado a partir de la interacción con la comunidad universitaria y buscando articular sus necesidades concretas, enmarcadas en las teorías provenientes de los Estudios para la Paz, así como en las problemáticas que atraviesa la democracia y la participación ciudadana en el país y la región. Una propuesta que busca generar un aporte a la tarea que viene desarrollando el IMLK de dicha universidad en la construcción de culturas de paz, siendo su objetivo general el «promover la democracia participativa y el ejercicio de la ciudadanía en Nicaragua»

Conflicto Anglo-Argentino. Los intereses en la disputa por la soberanía de las Islas Malvinas.

El conflicto Anglo-Argentino por la soberanía de las Islas Malvinas tiene un largo recorrido y una gran influencia en el ritmo de las relaciones entre ambos países. Una disputa que alcanzó su mayor pico de tensión con la Guerra de Malvinas en Abril de 1982 y que, pese a estar plagado de sucesos desde que se iniciara en 1833, no parece mostrar transformaciones significativas ni horizontes de salida negociada.En este trabajo se presenta una breve reseña de los principales acontecimientos que permitan un acercamiento panorámico a la complejidad del problema, para luego avanzar en una revisión interpretativa sobre las posiciones de ambos países, analizando los argumentos fundamentales de las pretensiones de soberanía sobre el archipiélago.En el mismo sentido se intentan indagar sobre los intereses que están presentes en el control de las Islas Malvinas y cómo, a partir de su análisis, se pueden explicar las posiciones de cada uno de los actores en el conflicto. Un ejercicio reflexivo sobre una disputa cuya trama colonial trasciende ampliamente la cuestión de la soberanía sobre las islas

Individual Factors Contributing to Nausea in First-Time Chemotherapy Patients: A Prospective Cohort Study

Objective: The expectation of developing side effects can enhance the likelihood to develop them – a phenomenon referred to as nocebo effect. Whether nocebo effects can be reduced by lowering negative expectancies, is not clear. The aim of this prospective study was to learn more about the factors contributing to nausea expectancy and their potential role in actual occurrence of nausea in patients undergoing chemotherapy for the first time in their life. Methods: Patients scheduled for moderately emetogenic chemotherapeutic regimens filled in questionnaires to assess state anxiety and quality of life and to rate the expectancy of nausea as a side effect of chemotherapy. Patient diaries were used to monitor the severity of post-chemotherapy nausea in the 4 days following chemotherapy administration. Bivariate analyses complemented by multiple regression analyses were performed to identify the relationship between nausea expectation and nausea occurrence. Results: 121 female patients (mean age 53 years) with completed questionnaires were included in the analyses. The majority of the patients had a diagnosis of breast cancer (86%). The two main sources for nausea expectancy were positive history of nausea in other situations and state anxiety. Patients with high expectancy levels (first quartile) experienced greater nausea than those with lower expectancy levels. Bivariate analyses revealed a weak but non-significant association between nausea expectation and post-chemotherapy nausea. When controlling for age, type of cancer, history of nausea, state and trait anxiety, and global quality of life, positive history of nausea (OR = 2.592; 95% CI, 1.0 to 6.67; p < 0.05), younger age (OR = 0.95; 95% CI, 0.92 to 0.99; p < 0.05), and a lower quality of life (OR = 0.97; 95% CI, 0.94 to 1.0; p < 0.05), but not nausea expectancy (OR = 1.014; 95% CI, 0.51 to 2.02; p = 0.969), predicted the occurrence of post-chemotherapy nausea. Conclusion: In this female cohort, younger patients with lower initial quality of life and a positive history of nausea were at higher risk to develop nausea after first time chemotherapy. These patients may benefit from psychological co-interventions that aim to enhance quality of life

Molecular and functional analysis of Drosophila single-minded larval central brain expression

Developmental regulatory proteins are commonly utilized in multiple cell types throughout development. The Drosophila single-minded (sim) gene acts as master regulator of embryonic CNS midline cell development and transcription. However, it is also expressed in the brain during larval development. In this paper, we demonstrate that sim is expressed in 3 clusters of anterior central brain neurons: DAMv1/2, BAmas1/2, and TRdm and in 3 clusters of posterior central brain neurons: a subset of DPM neurons, and two previously unidentified clusters, which we term PLSC and PSC. In addition, sim is expressed in the lamina and medulla of the optic lobes. MARCM studies confirm that sim is expressed at high levels in neurons but is low or absent in neuroblasts (NBs) and ganglion mother cell (GMC) precursors. In the anterior brain, sim+ neurons are detected in 1st and 2nd instar larvae but rapidly increase in number during the 3rd instar stage. To understand the regulation of sim brain transcription, 12 fragments encompassing 5’-flanking, intronic, and 3’-flanking regions were tested for the presence of enhancers that drive brain expression of a reporter gene. Three of these fragments drove expression in sim+ brain cells, including all sim+ neuronal clusters in the central brain and optic lobes. One fragment upstream of sim is autoregulatory and is expressed in all sim+ brain cells. One intronic fragment drives expression in only the PSC and laminar neurons. Another downstream intronic fragment drives expression in all sim+ brain neurons, except the PSC and lamina. Thus, together these two enhancers drive expression in all sim+ brain neurons. Sequence analysis of existing sim mutant alleles identified 3 likely null alleles to utilize in MARCM experiments to examine sim brain function. Mutant clones of DAMv1/2 neurons revealed a consistent axonal fasciculation defect. Thus, unlike the embryonic roles of sim that control CNS midline neuron and glial formation and differentiation, postembryonic sim, instead, controls aspects of axon guidance in the brain. This resembles the roles of vertebrate Sim that have an early role in neuronal migration and a later role in axonogenesis

Individual Factors Contributing to Nausea in First-Time Chemotherapy Patients: A Prospective Cohort Study

ObjectiveThe expectation of developing side effects can enhance the likelihood to develop them – a phenomenon referred to as nocebo effect. Whether nocebo effects can be reduced by lowering negative expectancies, is not clear. The aim of this prospective study was to learn more about the factors contributing to nausea expectancy and their potential role in actual occurrence of nausea in patients undergoing chemotherapy for the first time in their life.MethodsPatients scheduled for moderately emetogenic chemotherapeutic regimens filled in questionnaires to assess state anxiety and quality of life and to rate the expectancy of nausea as a side effect of chemotherapy. Patient diaries were used to monitor the severity of post-chemotherapy nausea in the 4 days following chemotherapy administration. Bivariate analyses complemented by multiple regression analyses were performed to identify the relationship between nausea expectation and nausea occurrence.Results121 female patients (mean age 53 years) with completed questionnaires were included in the analyses. The majority of the patients had a diagnosis of breast cancer (86%). The two main sources for nausea expectancy were positive history of nausea in other situations and state anxiety. Patients with high expectancy levels (first quartile) experienced greater nausea than those with lower expectancy levels. Bivariate analyses revealed a weak but non-significant association between nausea expectation and post-chemotherapy nausea. When controlling for age, type of cancer, history of nausea, state and trait anxiety, and global quality of life, positive history of nausea (OR = 2.592; 95% CI, 1.0 to 6.67; p &lt; 0.05), younger age (OR = 0.95; 95% CI, 0.92 to 0.99; p &lt; 0.05), and a lower quality of life (OR = 0.97; 95% CI, 0.94 to 1.0; p &lt; 0.05), but not nausea expectancy (OR = 1.014; 95% CI, 0.51 to 2.02; p = 0.969), predicted the occurrence of post-chemotherapy nausea.ConclusionIn this female cohort, younger patients with lower initial quality of life and a positive history of nausea were at higher risk to develop nausea after first time chemotherapy. These patients may benefit from psychological co-interventions that aim to enhance quality of life