Reducing Urinary Catheter Usage in the Intensive Care Unit Setting and Education Related to Preventing CAUTIs: A QI Project

Significance and Background: Catheter-associated urinary tract infections (CAUTIs) are common but preventable hospital-associated infections. The inappropriate and prolonged use of indwelling urinary catheters can pose a significant risk for patients and healthcare organizations. The Centers for Disease Control and Prevention identified that the most important factor related to an increased risk of CAUTI is the length of time an indwelling catheter remains in place. This DNP (Doctor of Nursing Practice) project assessed the barriers to removing indwelling catheters in the intensive care unit (ICU) while providing encouragement of prompt removal. Purpose: Three aims were developed for this quality improvement project: 1) Educate staff nurses in the ICU setting and encourage prompt removal of the indwelling urinary catheter; 2) Track compliance of utilizing catheter algorithm; and 3) Reduce the length of time an indwelling catheter remains in place. Intervention/Setting: For this project, the Institute for Healthcare Improvement was the model chosen to improve the quality of care. Plan, Do, Study, Act (PDSA) drove the changes in practice. Two PDSA cycles were completed, including pre-intervention surveys to discuss barriers, beliefs, and current knowledge related to indwelling catheters, educational sessions, and an algorithm to determine the continued need for a catheter. Participants included any nurse working in the intensive care unit from June 1st to August 12th, 2022. Evaluation: Pre-implementation survey revealed barriers associated with prompt removal by nurses, including convenience, inadequate staffing, patient immobility, and acuity of patients. Foley catheter use decreased by 20.3% with use of alternative measures and use of an algorithm, by the end of the 10-week implementation. The compliance rate of algorithm use increased by 55% by the end of the project. Discussion: Implementing education sessions and an algorithm to determine the continued use of an indwelling catheter can be helpful in an ICU setting when used appropriately. Despite this being a small ICU and other variables leading to the results, bringing awareness to the need for the prompt removal of a catheter can help reduce the length of days, leading to a reduced risk of developing a CAUTI

The complement system in COVID-19: Friend and foe?

Coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in a global pandemic and a disruptive health crisis. COVID-19-related morbidity and mortality have been attributed to an exaggerated immune response. The role of complement activation and its contribution to illness severity is being increasingly recognized. Here, we summarize current knowledge about the interaction of coronaviruses with the complement system. We posit that (a) coronaviruses activate multiple complement pathways; (b) severe COVID-19 clinical features often resemble complementopathies; (c) the combined effects of complement activation, dysregulated neutrophilia, endothelial injury, and hypercoagulability appear to be intertwined to drive the severe features of COVID-19; (d) a subset of patients with COVID-19 may have a genetic predisposition associated with complement dysregulation; and (e) these observations create a basis for clinical trials of complement inhibitors in life-threatening illness

3-Benzyl-2-(furan-2-yl)-1,3-thia­zolidin-4-one

In the title compound, C14H13NO2S, the thia­zolidine ring is approximately planar with a maximum deviation of 0.112 (1) Å. The furan ring is disordered over two orientations, with an occupancy ratio of 0.901 (5):0.099 (5). The central thia­zolidine ring makes dihedral angles of 85.43 (8), 87.50 (11) and 87.9 (9)° with the phenyl ring and the major and minor components of the disordered furan ring, respectively. In the crystal, mol­ecules are connected by weak inter­molecular C—H⋯O hydrogen bonds, forming supra­molecular chains parallel to the b axis

Integrated Aerodynamic and Mechanical Design of a Large-Scale Axial Turbine Operating With A Supercritical Carbon Dioxide Mixture

In this paper, the design of a large-scale axial turbine operating with supercritical carbon dioxide (sCO2) blended with sulfur dioxide (SO2) is presented considering aerodynamic and mechanical design aspects as well as the integration of the whole turbine assembly. The turbine shaft power is 130 MW, designed for a 100 MWe concentrated-solar power plant with turbine inlet conditions of 239.1 bar and 700 °C, total-to-static pressure ratio of 2.94, and mass-flow rate of 822 kg/s. The aerodynamic flow path, obtained in a previous study, is first summarized before the aerodynamic performance of the turbine is evaluated using both steady-state and unsteady three-dimensional numerical models. Whole-annulus unsteady simulations are performed for the last turbine stage and the exhaust section to assess the unsteady loads on the rotor due to downstream pressure field distortion and to assess the aerodynamic losses within the diffuser and exhaust section. The potential low engine order excitation at the last rotor stage natural frequency modes due to downstream pressure distortion is assessed. The design of the turbine assembly is constrained by current manufacturing capabilities and the properties of the proposed working fluid. High-level flow-path design parameters, such as pitch diameter and number of stages, are established considering a trade-off between weight and footprint, turbine efficiency, and rotordynamics. Rotordynamic stability is assessed considering the high fluid density and related cross coupling effects. Finally, shaft end sizing, cooling system design, and the integration of dry gas seals are discussed

Integrated Aerodynamic and Mechanical Design of a Large-Scale Axial Turbine Operating With Supercritical Carbon Dioxide Mixtures

In this paper, the design of a large-scale axial turbine operating with supercritical carbon dioxide (sCO2) blended with sulfur dioxide (SO2) is presented considering aerodynamic and mechanical design aspects as well as the integration of the whole turbine assembly. The turbine is 130 MW, designed for a 100 MWe concentrated-solar power plant with turbine inlet conditions of 239.1 bar and 700 °C, total-to-static pressure ratio of 2.94 and mass-flow rate of 822 kg/s. The aerodynamic flow path, obtained in a previous study, is first summarised before the aerodynamic performance is evaluated using both steady-state and unsteady 3D numerical models to simulate the aerodynamic performance of the turbine. Whole-annulus unsteady simulations are performed for the last turbine stage and the exhaust section to assess the unsteady loads on the rotor due to downstream pressure field distortion and to assess aerodynamic losses of the diffuser and exhaust section. The potential low engine order excitation on the last rotor stage natural frequency modes due to downstream pressure distortion is assessed. The design of the turbine assembly is constrained by current manufacturing capabilities and the proposed working fluid properties. High-level flow-path design parameters, such as pitch diameter and number of stages, are established considering a trade-off between weight and footprint, turbine efficiency and rotordynamics. Rotordynamic stability is assessed considering the high fluid density related to cross coupling effects. Finally, shaft end sizing, cooling system design and the integration of dry gas seals are discussed