Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period

Infrastructural Speculations: Tactics for Designing and Interrogating Lifeworlds

This paper introduces “infrastructural speculations,” an orientation toward speculative design that considers the complex and long-lived relationships of technologies with broader systems, beyond moments of immediate invention and design. As modes of speculation are increasingly used to interrogate questions of broad societal concern, it is pertinent to develop an orientation that foregrounds the “lifeworld” of artifacts—the social, perceptual, and political environment in which they exist. While speculative designs often imply a lifeworld, infrastructural speculations place lifeworlds at the center of design concern, calling attention to the cultural, regulatory, environmental, and repair conditions that enable and surround particular future visions. By articulating connections and affinities between speculative design and infrastructure studies research, we contribute a set of design tactics for producing infrastructural speculations. These tactics help design researchers interrogate the complex and ongoing entanglements among technologies, institutions, practices, and systems of power when gauging the stakes of alternate lifeworlds

Young women, sexuality and Protestant church community: oppression or empowerment?

Although Christianity's clout on sexuality has generally declined in Britain due to secularization, contemporary conservative Protestantism continues to encourage a conventional construction of sexuality — sex is only for the context of heterosexual marriage. Qualitative interviews with 26 heterosexual women and two lesbian women on how their Protestant church involvement impacted their sexuality revealed the pervasive discourse of a marital-confined sexuality and participants' sense of `accountability' to the group for carrying this out. Such accountability can result in a repressed sexuality that is oppressive. Alternatively, it can produce a `sense of community' that functions as a source of empowerment. The oppressive and empowering nature of accountability, however, can be difficult to untangle because of women's religious commitment and supportive friendships found in church life. Relying on participants' accounts, this article addresses the oppression and empowerment young women experience when they negotiate their gendered identities in relation to a marital-confined sexuality