Evaluation of a Critical-Care Pain Observation Tool Quality Initiative

Background: Patients unable to self-report pain are at increased risk for inadequate pain management and less than optimal outcomes. The implementation of behavioral pain scales, such as the Critical-Care Pain Observation Tool (CPOT), have demonstrated an improvement in pain management and patient outcomes. Local Problem: A lack of the routine use of behavioral pain scales for mechanically ventilated patients unable to self-report pain was identified as a significant barrier to optimal pain and agitation management. Methods: A retrospective pre and post design was used to evaluate the effectiveness and impact of a CPOT quality initiative on the management of pain, agitation and patient outcomes. Descriptive data for analysis were extracted from 60 electronic medical records, 30 for both the pre- and post-implementation groups. Interventions: The quality initiative included training sessions, unit champions, clinical support tools and the incorporation of the CPOT into unit pain management guidelines and several analgesic order sets. Results: CPOT pain assessments (p \u3c .001) were more frequent in the post-implementation group. There number of PRN analgesics were found to be greater in the post-implementation group, while the tendency for the total morphine equivalent dosage was lower. No differences were found between the pre- and post-implementation groups with regard to sedation and agitation management and patient outcomes. Conclusions: The quality initiative was successful in increasing the routine use of the CPOT. Pain management of mechanically ventilated patients in this critical setting improved. Multidisciplinary participation and unit champions were vital to the success of this quality initiative

A live weight-heart girth relationship for accurate dosing of east African shorthorn zebu cattle

The accurate estimation of livestock weights is important for many aspects of livestock management including nutrition, production and appropriate dosing of pharmaceuticals. Subtherapeutic dosing has been shown to accelerate pathogen resistance which can have subsequent widespread impacts. There are a number of published models for the prediction of live weight from morphometric measurements of cattle, but many of these models use measurements difficult to gather and include complicated age, size and gender stratification. In this paper, we use data from the Infectious Diseases of East Africa calf cohort study and additional data collected at local markets in western Kenya to develop a simple model based on heart girth circumference to predict live weight of east African shorthorn zebu (SHZ) cattle. SHZ cattle are widespread throughout eastern and southern Africa and are economically important multipurpose animals. We demonstrate model accuracy by splitting the data into training and validation subsets and comparing fitted and predicted values. The final model is weight0.262 =0.95 + 0.022 × girth which has an R2 value of 0.98 and 95 % prediction intervals that fall within the ±20 % body weight error band regarded as acceptable when dosing livestock. This model provides a highly reliable and accurate method for predicting weights of SHZ cattle using a single heart girth measurement which can be easily obtained with a tape measure in the field setting

Optimizing community-driven development through sage tradition in Cameroon

Powering community development requires a re-invention of traditional authority. This paper interrogates this proposition: how does sage tradition engender social resilience and what is the impact of traditional authority on the modern governance architecture? Sage tradition construed culturally as elder-led authority is anchored on wisdom and respect for elders—a pivotal asset in community development transactions. Informed by indigenous knowledge, social capital and asset-based concepts, an empirical account of strategic leadership by the elderly is proffered, uncovering indigenous governance in the North West Region, Cameroon. A pyramidal power structure validates village elders as key players in advancing social justice. They offer counsel and arbitrate in community affairs and mobilise community members for infrastructure provision—community halls, equipping schools, digging roads, building bridges and supply of fresh water. Though elder esteemed traditions prove perfunctory, findings show communities are benefiting from the accumulated, incremental cultural assets factored into local development. The paper concludes that thriving cultural assets should be amalgamated through a policy drive that taps into the utility of traditional authority, in synergy with modern state institutions to bolster social development, address poverty and social inequality

Dynamic political contexts and power asymmetries: the cases of the Blue Nile and the Yarmouk Rivers

This paper explores the evolving patterns of hydropolitical relations in the dynamic contexts of Yarmouk and Blue Nile Rivers in comparison. The analysis aims at shedding light over the complex implications that recent political and social changes have aroused for the water disputes between Jordan and Syria on the one hand, and Ethiopia and Egypt on the other. In both basins, cooperative efforts toward the integrated management of transboundary waters have been only partially effective and largely undermined by the perpetuation of unilateral actions by riparian states. In the case studies, the lack of a basin-wide vision over the control and use of shared waters has resulted in disputes among the basin states and ultimately in an unsustainable, unfair, and unwise utilization of the resources. This paper argues that a substantive and effective integration of national water policies is unlikely to occur, unless power asymmetries are properly addressed in order to overcome the likelihood of hegemonic regimes

Benthic algal response to N and P enrichment along a pH gradient

Nutrient enrichment and its effect on benthic algal growth, community composition, and average cell size was assessed across two sites of differing pH within a single habitat. Nutrients were added using in situ substrata, which released either N, P, or no additional nutrients (controls) at each site for 21 days. Upon collection, chlorophyll and biovolume standing stocks of the attached algal microflora were measured. Chlorophyll concentration was different among all treatments, accumulating greatest on P, followed by N, and the least on C substrata (P < 0.001) and was highest at site-2 (P < 0.001), while total algal biovolume was highest on P compared to both N and C substrata (P < 0.05) and did not vary between sites. Increased growth on P substrata was due to the enhanced biovolume of filamentous green algae, although the affected taxa varied between sites. Biovolume to cell density ratios (as a measure of average cell size) were highest on P substrata over both N-enriched and control substrata (P < 0.05) and this pattern was similar between sites. Progression towards a community composed of larger cells following P enrichment observed along this pH gradient, seems to be related to the dominance of larger celled filamentous green algae. Thus, nutrients exhibited greater control on benthic algal growth than did changes in hydrogen ion concentration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42877/1/10750_2004_Article_BF00007599.pd