Nursing Management to Reduce Hospital Readmissions after Percutaneous Coronary Interventions- Integrative Review

Abstract Percutaneous coronary interventions (PCIs) are considered life-saving techniques in the event of myocardial infarction and remain the standard of care for managing acute heart attack. Given the success of the procedures, decreased complications, and the economic advantage over open-heart surgery, coronary interventions continue to be the preferred treatment choice. However, amidst the growth and success of these procedures, readmissions after percutaneous coronary interventions have been identified and still prevail among hospitals. Hence, the goal was to conduct an integrative review to identify and synthesize literature on the interventions that help reduce readmissions after percutaneous coronary interventions and illuminate nurses\u27 role in decreasing readmissions. The following review question guided the integrative review: What nursing interventions reduce hospital readmissions after patients undergoing percutaneous coronary interventions? Whittemore and Knafl\u27s (2005) framework was used for the integrative review. A total of eight studies, quantitative in nature, met the quality criteria to be included. Three themes related to the research questions emerged: evidence-based process interventions in place, management for women after PCI, and patient education and follow-up appointments. The findings provide a clear opportunity to improve care relative to the causes of preventing readmissions. Further research is needed to identify why females are more affected than men and to determine interventions based on those factors. Further research is also needed to assess nurse-led intervention\u27s impact on readmissions for PCI. Keywords: Percutaneous coronary intervention, nurse, readmission

Information Technologies and Education for the Poor in Africa: Recommendations for a Pro-Poor ICT4D Non-Formal Education Policy

More than half of Africa\u27s youth and adults do not have basic literacy skills and/or have not completed primary or secondary school. It is deeply concerning how little serious attention has been paid to the potential ways in which ICT can enhance such skills, as part of a pro-poor model of ICT for Development (ICT4D). Such work is crucial if the goals of Education for All (EFA) and the Millennium Development Goals (MDG) are to be achieved. The present effort, Information Technologies and Education for the Poor in Africa (ITEPA), is designed to focus attention on what is being and has been attempted in this domain in some of the poorest communities in Africa

Resonant vibrations, peak broadening and noise in single molecule contacts: beyond the resonant tunnelling picture

We carry out experiments on single-molecule junctions at low temperatures, using the mechanically controlled break junction technique. Analyzing the results received with more than ten different molecules the nature of the first peak in the differential conductance spectra is elucidated. We observe an electronic transition with a vibronic fine structure, which is most frequently smeared out and forms a broad peak. In the usual parameter range we find strong indications that additionally fluctuations become active even at low temperatures. We conclude that the electrical field feeds instabilities, which are triggered by the onset of current. This is underscored by noise measurements that show strong anomalies at the onset of charge transport

Toward Defining Literacy

Literacy is a topic much on the public\u27s mind these days. It is one of those subjects on which all laypersons think they are experts. When it comes time, however, to establish measures of illiteracy rates or to set policies, it becomes apparent that we know less than we thought we did. It is small comfort to know that specialists also have their differences

Isotope or mass encoding of combinatorial libraries

Background: Combinatorial chemistry using solid-phase synthesis is a rapidly developing technology that can result in a significant reduction in the time required to find and optimize lead compounds. The application of this approach to traditional medicinal chemistry has led to the construction of libraries of small organic molecules on resin beads. A major difficulty in developing large combinatorial libraries is the lack of a facile encoding and decoding methodology to identify active compounds.Results: Several encoding schemes are described which use the ability of mass spectrometry to ascertain isotopic distributions. Molecular tags are attached to resin beads in parallel or on the linker used for chemical library synthesis. The tags are encoded via a controlled ratio of a number of stable isotopes on the tagging molecules, and range from a single to a complex isotopic distribution.Conclusions: A novel coding scheme is described that is useful for the generation of large encoded combinatorial libraries. The code can be cleaved after assay and analyzed by mass spectrometry in an automated fashion. An important element of the combinatorial discovery process is the ability to extract the structure-activity relationship (SAR) information made available by library screening. The speed and sensitivity of the mass-encoding scheme has the potential to determine the full SAR for a given library

Evaluation of depolarization changes during acute myocardial ischemia by analysis of QRS slopes.

OBJECTIVE: This study evaluates depolarization changes in acute myocardial ischemia by analysis of QRS slopes. METHODS: In 38 patients undergoing elective percutaneous coronary intervention, changes in upward slope between Q and R waves and downward slope between R and S waves (DS) were analyzed. In leads V1 to V3, upward slope of the S wave was additionally analyzed. Ischemia was quantified by myocardial scintigraphy. Also, conventional QRS and ST measures were determined. RESULTS: QRS slope changes correlated significantly with ischemia (for DS: r = 0.71, P < .0001 for extent, and r = 0.73, P < .0001 for severity). Best corresponding correlation for conventional electrocardiogram parameters was the sum of R-wave amplitude change (r = 0.63, P < .0001; r = 0.60, P < .0001) and the sum of ST-segment elevation (r = 0.67, P < .0001; r = 0.73, P < .0001). Prediction of extent and severity of ischemia increased by 12.2% and 7.1% by adding DS to ST. CONCLUSIONS: The downward slope between R and S waves correlates with ischemia and could have potential value in risk stratification in acute ischemia in addition to ST-T analysis

The effects of dry-rolled corn particle size on performance, carcass traits, and starch digestibility in feedlot finishing diets containing wet distiller's grains

Citation: Schwandt, E. F., Wagner, J. J., Engle, T. E., Bartle, S. J., Thomson, D. U., & Reinhardt, C. D. (2016). The effects of dry-rolled corn particle size on performance, carcass traits, and starch digestibility in feedlot finishing diets containing wet distiller's grains. Journal of Animal Science, 94(3), 1194-1202. doi:10.2527/jas2015-9408Crossbred yearling steers (n = 360; 395 +/- 33.1 kg initial BW) were used to evaluate the effects of dry-rolled corn (DRC) particle size in diets containing 20% wet distiller's grains plus solubles on feedlot performance, carcass characteristics, and starch digestibility. Steers were used in a randomized complete block design and allocated to 36 pens (9 pens/treatment, with 10 animals/pen). Treatments were coarse DRC (4,882 mu m), medium DRC (3,760 mu m), fine DRC (2,359 mu m), and steam-flaked corn (0.35 kg/L; SFC). Final BW and ADG were not affected by treatment (P > 0.05). Dry matter intake was greater and G:F was lower (P 0.10) were observed among treatments for any of the carcass traits measured. Results indicate improved ruminal starch digestibility, reduced fecal starch concentration, and reduced DMI with decreasing DRC particle size in feedlot diets containing 20% wet distiller's grains on a DM basis

Endothelial cells decode VEGF-mediated Ca2+ signaling patterns to produce distinct functional responses

A single extracellular stimulus can promote diverse behaviors among isogenic cells by differentially regulated signaling networks. We examined Ca2+ signaling in response to VEGF (vascular endothelial growth factor), a growth factor that can stimulate different behaviors in endothelial cells. We found that altering the amount of VEGF signaling in endothelial cells by stimulating them with different VEGF concentrations triggered distinct and mutually exclusive dynamic Ca2+ signaling responses that correlated with different cellular behaviors. These behaviors were cell proliferation involving the transcription factor NFAT (nuclear factor of activated T cells) and cell migration involving MLCK (myosin light chain kinase). Further analysis suggested that this signal decoding was robust to the noisy nature of the signal input. Using probabilistic modeling, we captured both the stochastic and deterministic aspects of Ca2+ signal decoding and accurately predicted cell responses in VEGF gradients, which we used to simulate different amounts of VEGF signaling. Ca2+ signaling patterns associated with proliferation and migration were detected during angiogenesis in developing zebrafish