LOUIS University of Alabama in Huntsville
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Implementing a monitoring checklist for veterans diagnosed with congestive heart failure
No full textCongestive heart failure (CHF) is one of the leading ambulatory care sensitive conditions (ACSC) that lead to unplanned readmissions in the United States and among veterans of the Atlanta Veterans Healthcare System (AVAHCS). Patients who are diagnosed with CHF can incur medical and financial difficulties that have substantial negative impacts on their health outcomes and quality of life. This project implemented a checklist for the weekly monitoring of the care of veterans who have been hospitalized for CHF exacerbations in the last 12 months, and who have a 50% or higher 3-month probability (3M) risk of unplanned readmission. This nurse-based monitoring care process puts the registered nurse (RN) care manager in the center of the care of the veteran. A repeated measures test was used to analyze the pre- and post- implementation data, to determine statistical significance of the implemented variable. The pre- and post - data analyzed include, 1) Preadmission date/frequency, and 2) 3M score pre and post
Assembly and analysis of space biofilm-forming bacterial model organisms towards the treatment of water system biofilms
No full textSpace exploration imposes unique challenges on the human body and engineered systems alike. One such challenge is the control of microbial life, specifically biofilms, within the water processor assembly of the International Space Station (ISS). This investigation aimed to determine the feasibility of using an innovative bioremediation approach to mitigate biofilm growth in the water processor assembly. This approach entails the dissemination of a desired anti-biofilm gene across the microbial population of the water processor assembly through horizontal gene transfer via conjugation. To ascertain the viability of this method, the research was divided into two primary focuses. The first part sought to identify the microbial inhabitants of the Water Processor Assembly (WPA), characterizing their genomes and their capacity for gene exchange. The second part was devoted to evaluating the potential for transferring a previously studied anti-biofilm gene -alterocin- to various organisms through a plasmid, thereby modeling future tests for the conjugative spread of bioremediation strategies. Sequencing of the genomes of five biofilm-forming gram-negative bacterial strains isolated from the ISS was performed to understand the genetic mechanisms that confer resistance and biofilm formation. The work further extends to analyzing the genetic features and functions of these bacteria by comparing their chromosomes and plasmids against a broader dataset, consisting of 48 plasmids from other flight bacteria. An in-depth analysis of the bacterial chromosomes revealed genetic differences compared to their ground-based counterparts, thereby showing potential adaptive strategies in the given ISS conditions. Our analysis also identified resistances to hexavalent chromium, a key component in the urine pretreat system of the ISS, along with resistances to zinc and nickel. Several plasmids showed high levels of similarity and were identified in different organisms, suggesting horizontal gene transfer as a potential mechanism for spreading resistance traits. Evaluation of flight bacterial prevalence in the ISS water systems was conducted to comprehend the overall microbial landscape. Furthermore, this research aimed to engineer a mobilizable plasmid capable of expressing the alterocin protein to mitigate biofilm formation. These findings contribute to the growing body of knowledge on microbial life in space built environments, such as water systems in ISS, and offer potential avenues for the design of measures to control microbial growth, including the development of engineered plasmids that could aid in effective biofilm management
Fast Track to Success: Frank Shoreland and the Cuca Cocoa Challenge Cup
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A quality improvement project : improving sexually transmitted infection screening, treatment and contraceptive initiation and continuation in a carceral setting
No full textScreening in the carceral setting for sexually transmitted infections and contraceptive needs is an opportune time to impact the equity health of the adult female in custody as well as public health. The prevalence of undiagnosed chlamydia and gonorrhea infections in a carceral setting is prevalent. Untreated sexually transmitted infections in females may lead to lifelong health implications such as pelvic inflammatory disease, increased risk for ectopic pregnancy, infertility and increased risk of acquiring human immunodeficiency virus. Unintended pregnancy rates among adult females in custody is double the rate of the general population. Multiple research studies have shown that adult females in custody desire the opportunity to access or continue contraceptives while in custody. The purpose of this clinical practice change project was to increase opportunities to continue or initiate contraceptives and increase screening for adult females in custody. This clinical practice change project addressed staff education regarding contraceptives use and sexually transmitted infection screening in a population that struggles with social determinants of health, such as poverty and transportation that impact their health care access. The population for this project included the medical staff at the Douglas, County jail in Roseburg, Oregon. The medical staff received training on contraceptives and opt out screening for sexually transmitted infections. The impact on adult females in custody as a result of the training received by the medical staff was evaluated. Adult females in custody received opt out screening for chlamydia and gonorrhea and education on options to request contraceptives while in custody. They had the opportunity to self-refer themselves to the medical clinic to address questions and concerns regarding sexually transmitted infection screening and contraceptive questions and options. Rates of sexually transmitted infection screening, contraceptive prescriptions and community referrals post release were compared to the same 12-week period in 2022. The results indicate when education is provided to the medical staff related to the importance of contraceptive access and continuity in contraceptives, use increased. In addition, when education was provided on opt out screening for sexually transmitted infections and the impact on individual and community health, screening rates increased
Increasing type 2 diabetes mellitus self-efficacy in a rural primary care clinic using telehealth education
No full textType 2 diabetes mellitus is a chronic disease that causes a burden to people with the illness, to their families, and to the healthcare system worldwide. It is a preventable noncommunicable disease that causes significant economic global impacts, especially in areas of rurality and low socioeconomic status. Despite its prevalence in the United States, type 2 diabetes mellitus still poses increased rates of complications and mortality due to ineffective management, improper skills, and lack of knowledge to care for oneself. In addition, this population often lacks self-efficacy or the belief that they can manage and perform tasks to promote desired outcomes and improve quality of life. Diabetes self-management education and support are necessary for patients with all types of diabetes but are highly underutilized, especially in rural communities that lack the resources and availability. Telehealth education and support can provide the knowledge, skills, and confidence necessary to increase self-efficacy in patients with type 2 diabetes. In rural communities, the use of telehealth or virtual-based education is recommended to reach wide populations and can improve glycemic control. Telehealth-based group education classes have shown positive results in improving HgA1c, self-efficacy, and weight reduction. This evidence-based practice project utilized Zoom group education class sessions with self-reported at-home weekly activities to increase self-efficacy in people with type 2 diabetes mellitus to improve HgA1c and weight over a period of 12 weeks. The project was conducted at a rural family practice clinic in Alabama utilizing 12 patients with T2DM. Results of this intervention provided statistically significant reduction of HgA1c and weight over 12 weeks and statistically significant improvement in self-efficacy scores. The results of the scholarly project indicate that the use of telehealth diabetes education for rural populations is impactful
Implementation of a protocol to prevent moderate or severe alcohol withdrawal syndrome in hospitalized patients
No full textAlcohol Use Disorder is as a chronic relapsing brain disease encompassing a diminished ability to stop or control alcohol use regardless of the social, health, or occupational consequences. The abrupt cessation of alcohol without appropriate screening and treatment may produce acute alcohol withdrawal that can present as agitation, diaphoresis, palpitations, or moderate and severe withdrawal. The purpose of this DNP project was to implement the Prediction of Alcohol Withdrawal Severity Scale to identify patients at risk for moderate or severe alcohol withdrawal in patients with alcohol abuse disorder or history of alcohol withdrawal. The project involved admitted patients aged 18 years or older with current alcohol use and provider entry on problem list of alcohol abuse disorder, alcohol abuse, or chronic alcohol withdrawal in an acute care hospital medical-surgical unit. The project design was an evidence-based clinical practice change and involved utilization of the Prediction of Alcohol Withdrawal Severity Scale screening tool on inpatients diagnosed with alcohol use disorder in efforts to predict and treat patients at risk for moderate or severe alcohol withdrawal. Patients diagnosed with alcohol withdrawal who were screened with the Prediction of Alcohol Withdrawal Severity Scale were reviewed to determine if they progressed to moderate or severe withdrawal. The project was able to identify patients at risk for moderate or severe withdrawal that led to both a reduction in those patients who went into withdrawal as well as a reduction in the number of patients who transferred to the intensive care unit, overall decreasing healthcare costs. The use of a screening tool to predict moderate or severe alcohol withdrawal provides an effective preventative framework in the treatment of patients who present with alcohol use disorder. Further review is needed regarding this screening tool in conjunction with medication regimes for treatment of alcohol withdrawal symptom management
A computational investigation of firebrand dispersion and deposition in areas with cubic structures
Get PDFThe spread of wildland and wildland urban interface (WUI) fires can be caused by spotting, where embers from a primary fire ignite spot fires. This study investigates the dispersion and deposition of firebrands over cubic structures in WUI regions under wind condition. Large eddy simulation was used for turbulence while tracing firebrands in Lagrangian framework, employing the open source software Fire Dynamics Simulator (FDS). The software program was revised to include a firebrand model where the rotational motion and thermal degradation of firebrands were taken into account in addition to the translation motion. This was used for simulation of cylindrical. The simulation included a firebrand depositing over single isolated block and multiple neighboring blocks in different configurations with varying wind speeds and separation distances. Both scenarios showed a safe zone on the leeward side of the blocks where no firebrands were deposited. The safe zone had a rectangular shape, with width matching the block and length proportional to the block’s height and wind speed. For tandem blocks, the safe zone extended onto the windward face of the trailing block with smaller separation distances and higher wind speeds. No firebrands were observed to deposit on the leeward face of the blocks in either scenario. The normalized number density (NND) of deposited firebrands was analyzed based on landing positions. At lower wind speeds, fewer firebrands were deposited on the top face of the block compared to the ground. Additionally, for blocks with longer length, the concentration of firebrands increased towards the trailing edge. Another firebrand model was developed and integrated in FDS to investigate the deposition and accumulation of cuboidal firebrands released from a firebrand-generating apparatus (Dragon) onto two adjacent blocks, as observed in previous experiments by Suzuki and Manzello [75]. In this model, firebrands were assumed to be influenced by drag and gravity during flight, and by drag and friction while sliding on the ground. These simulation revealed various flow features such as, the re-circulating region in the dragon’s wake, crossflow region upwind of the blocks and twin re-circulation region on the leeward side of the blocks affecting firebrand motion. At lower wind speeds, firebrands tended to accumulate between the dragon and the blocks. Conversely, at higher wind speeds, the firebrands tended to cluster momentarily before the crossflow region and then move swiftly through the space between the blocks, with some exiting the domain and others accumulating on the leeward edge of the blocks. The dispersion of firebrands was found to be significantly greater in the streamwise direction compared to the spanwise direction due to the higher rms velocity in the former direction
The structural basis of inflammation : computational characterization of molecular mechanisms
No full textComputational tools are useful in the interpretation and analysis of experimental data. In the world of structural biophysics, computational tools go a bit further: they can simulate atomic motions and molecular interactions based on experimentally-determined biomolecule structures, therein describing natural phenomena, and inspiring the formulation of new hypotheses. In this work, computational structural biology tools are used to answer questions about molecules of inflammatory importance. Quantum chemistry computational tools are used to determine the electronic structure of sesamin, a component of many diets which may be a modulator of an enzyme involved in the metabolism of inflammation mediators. Virtual docking of small molecules is conducted on the SARS-CoV-2 polymerase to determine potential lead molecules’ interactions in the catalytic site. Select compounds are identified as promising inhibitors and are suggested for wet lab study in anti-viral assays. Finally, molecular modeling and dynamics simulations are performed on T cell receptors whose sequences are specific to individuals with PTSD. Structural differences in the receptors after long timescale dynamics simulations suggest a reason to investigate whether a functional discrepancy may exist as an immune marker of PTSD
Using Pulsating White Dwarfs as Accelerometers
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