Improving Emergence and Awaken Time in the Obese Population: Development of a Desflurane Protocol in the Obese Population

Studies have shown that obese patients are at an increased risk for apnea and aspiration during the postoperative period due to comorbidities associated with obesity (Nason, 2015). Complications such as apnea and aspiration can increase the length of stay in the post-operative care unit (PACU). Slower emergence further increases the risk for apnea and aspiration because of delayed return of protective reflexes (Brousseau, Dobson, & Milne, 2014). Evidence-based research has shown Desflurane to have the fastest wake-up times in obese patients when compared to Sevoflurane, Isoflurane, and Propofol (Juvin, Vadam, Malek, Dupont, Marmuse, & Desmonts, 2000). The goal of this project was to create a Desflurane protocol to be used in the obese population and educate the staff at a rural hospital in Central Illinois. The results of the project showed an increase in support from the anesthesia staff to use the Desflurane protocol in the obese population

Helpless helpers: primary care therapist self-efficacy working with intimate partner violence and aging women

Purpose: To explore primary care psychological therapists’ experiences of working with\ud midlife and older women presenting with intimate partner violence and develop a theoretical\ud framework using a grounded theory approach to identify the experiences of those\ud practitioners working with this phenomenon. Methodology: Interviews with 17 practitioners were conducted. The data analysis was\ud informed by a grounded theory approach, which requires three states of data coding: open,\ud axial and selective. Data codes were thematically sorted into causal, contextual, strategic,\ud intervening, interactional and consequential conditions. Findings: A core state of therapist helplessness was uncovered. The framework demonstrates\ud that psychological therapists doubt their ability to work meaningfully with women over 45\ud experiencing IPV. To avoid the core state of helplessness therapists use strategies such as\ud avoiding asking questions about partner violence, making assumptions of how patients\ud interpret their own experiences, addressing symptoms rather than the root cause, and going\ud above and beyond in attempts to rescue patients. The consequence of therapists’ helplessness\ud often results in burnout. Implications: The framework identifies barriers in working effectively with intimate partner\ud violence and women in the mid to older aged populations. Originality/Value: This study is the first to suggest a framework that is grounded in\ud practitioner experience with the capability to transfer to a range of professionals working\ud with mid to older aged women such as forensic, medical and specialist psychologists

The nature of egg production in Australian broiler-type hens

The results of experiments described in this thesis fall into two categories: (a) The effects of restriction of nutrient intake during rearing on laying house performance of broiler breeders, the nature of the production response and concomitant changes in the reproductive system. (b) The characteristics of normal egg production by broiler— breeders, follicular growth and ovulation, and the effects of ad libitum provision of calcium to these hens

Built Environment and Preterm Birth

Background. Preterm birth affects approximately 500,000 babies a year in the United States. One out of nine babies born in the United States deliver before 37 weeks gestation. Preterm birth can cause lifelong neurological problems, cerebral palsy, vision and hearing impairments, and developmental delay. The estimated $26 billion a year in preterm birth related costs are staggering to the health care system. Preterm-related causes of death in 2008 together accounted for 35% of all infant deaths. Methods. This paper is a review of the literature published (2006-2012) on the relationship between neighborhood environment and preterm birth. Results. Neighborhood deprivation and the neighborhood environment were associated with low-birth weight and preterm birth. Examples of neighborhood deprivation include economic deprivation, social disorder, and lack of health resources. Neighborhood environment can be described as neighborhood physical deterioration, violent crime, and group density. Conclusions. A significant association exists between the neighborhood environment and birth outcomes. More research is needed to explore interventions with a systems approach to promote healthy maternal behavior, reduce stress, and improve care for expecting mothers living in stressful neighborhood environments in order to reduce preterm births

Process for removal and recovery of phenolic compounds from switchgrass

Introduction This paper describes a process for the separation and recovery of non-structural phenolic compounds from switchgrass. This process is proposed as a preliminary step of a biorefinery incorporating the organosolv process for biomass fractionation. The economics of such an addition to separate and recover phenolic compounds is then investigated. Switchgrass has been selected as a dedicated feedstock for bioprocesses producing liquid fuels such as ethanol and advanced fuels. The University of Tennessee has been heavily involved in the development of switchgrass as one of the feedstocks for bioenergy production in the southeast (Tiller 2011). Biofuels have the potential to address problems related to fossil fuels such as carbon emissions, as long as they are produced sustainably while reducing risks to food security, wildlife, land, water, and air resources. Switchgrass can be grown on underutilized or marginal land where there is no or minimal competition with land that is used for food crop production. In addition, switchgrass does not require irrigation due to its inherent drought tolerance, and is a low input crop for producing bioenergy from farmland. With an extensive root system, switchgrass provides significant positive environmental benefits, prevents erosion, improves soil structure, and sequesters carbon in the soils. Please click Additional Files below to see the full abstract

Left Atrial Function Is Associated with Earlier Need for Cardiac Surgery in Moderate to Severe Mitral Regurgitation: Usefulness in Targeting for Early Surgery

BACKGROUND: The aim of this study was to determine whether assessment of left atrial (LA) function helps identify patients at risk for early deterioration during follow-up with mitral valve prolapse and mitral regurgitation. METHODS: Patients with moderate to severe mitral regurgitation but no guideline-based indications for surgery were retrospectively identified from a dedicated clinical database. Maximal and minimal LA volumes were used to derive total LA emptying fraction ([maximal LA volume - minimal LA volume]/maximal L volume × 100%). Average values of peak contractile, conduit, and reservoir strain were obtained using two-dimensional speckle-tracking imaging. The study outcome was time to mitral surgery. RESULTS: One hundred seventeen patients were included; median follow-up was 18 months. Sixty-eight patients underwent surgery. Receiver operating characteristic curves were used to derive optimal cutoffs for TLAEF (>50.7%) and strain (reservoir, >28.5%; contractile, >12.5%). Using Cox analysis, TLAEF and contractile, reservoir, and conduit strain were univariate predictors of time to event. After multivariate analysis, TLAEF (hazard ratio, 2.59; P = .001), reservoir strain (hazard ratio, 3.06; P < .001), and contractile strain (hazard ratio, 2.01; P = .022) remained independently associated with events, but conduit strain did not. Using Kaplan-Meier curves, event-free survival was considerably improved in patients with values above the derived thresholds (TLAEF: 1-year survival, 78 ± 5% vs 28 ± 8%; 3-year survival, 68 ± 6% vs 13 ± 5%; P < .001 for both; reservoir strain: 1-year survival, 79 ± 5% vs 29 ± 7%; 3-year survival, 67 ± 6% vs 15 ± 6%; P < .001 for both; contractile strain: 1-year survival, 80 ± 5% vs 41 ± 7%; 3-year survival, 69 ± 6% vs 24 ± 6%; P < .001 for both). CONCLUSION: LA function is independently associated with surgery-free survival in patients with mitral valve prolapse and moderate to severe mitral regurgitation. Quantitative assessment of LA function may have clinical utility in guiding early surgical intervention in these patients

Groundwater Remediation Using Modified Biochar

Biochar, a lightweight black residue made of carbon, has proved to be an effective adsorbent to remove TCE from groundwater. Not only is it an economical substitute for conventional adsorbents but it can be created by using a variety of organic materials. For this project, it will rely on walnut shell feedstock to create biochar as this had the best ability to adsorb TCE.https://digitalscholarship.unlv.edu/durep_posters/1131/thumbnail.jp

Mechanism of Cu-catalyzed aryl boronic acid halode-boronation using electrophilic halogen : development of a base-catalyzed Iododeboronation for radiolabeling applications

The authors are grateful to EPSRC (EP/R511705/1 and a studentship to K.M.O., EP/K503058/1) and the University of Glasgow. We thank the University of St Andrews (M.J.W) and CAPES/Science Without Borders (C.P.F) for PhD studentships.An investigation into the mechanism of Cu-catalyzed aryl boronic acid halodeboronation using electrophilic halogen reagents is reported. Evidence is provided to show that this takes place via a boronate-driven ipso-substitution pathway and that Cu is not required for these processes to operate: general Lewis base catalysis is operational. This in turn allows the rational development of a general, simple, and effective base-catalyzed halodeboronation that is amenable to the preparation of 125I-labeled products for SPECT applications.Publisher PDFPeer reviewe

A PDCD1 Role in the Genetic Predisposition to NAFLD-HCC?

Obesity and non-alcoholic fatty liver disease (NAFLD) are contributing to the global rise in deaths from hepatocellular carcinoma (HCC). The pathogenesis of NAFLD-HCC is not well understood. The severity of hepatic steatosis, steatohepatitis and fibrosis are key pathogenic mechanisms, but animal studies suggest altered immune responses are also involved. Genetic studies have so far highlighted a major role of gene variants promoting fat deposition in the liver (PNPLA3 rs738409; TM6SF2 rs58542926). Here, we have considered single-nucleotide polymorphisms (SNPs) in candidate immunoregulatory genes (MICA rs2596542; CD44 rs187115; PDCD1 rs7421861 and rs10204525), in 594 patients with NAFLD and 391 with NAFLD-HCC, from three European centres. Associations between age, body mass index, diabetes, cirrhosis and SNPs with HCC development were explored. PNPLA3 and TM6SF2 SNPs were associated with both progression to cirrhosis and NAFLD-HCC development, while PDCD1 SNPs were specifically associated with NAFLD-HCC risk, regardless of cirrhosis. PDCD1 rs7421861 was independently associated with NAFLD-HCC development, while PDCD1 rs10204525 acquired significance after adjusting for other risks, being most notable in the smaller numbers of women with NAFLD-HCC. The study highlights the potential impact of inter individual variation in immune tolerance induction in patients with NAFLD, both in the presence and absence of cirrhosis