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A Nazi War Criminal Reflects On The War In Russia
Get PDFThe name Joachim (or “Jochen”) Peiper is instantly recognizable to any American with a passing knowledge of World War II. He was the commander of the Waffen-SS battlegroup held responsible for the “Malmédy massacre” of American prisoners of war during Hitler’s Ardennes offensive. At the time of his 1946 trial by a U.S. Army court, he was called “the most hated man in the United States.” Given the crimes of which he was accused – the slaughter of hundreds of POWs and Belgian civilians –this is easy to understand. Less so is the attention that this man- a relatively minor figure in the host of World War II villains-has attracted over the three-quarters of a century since its end. Peiper’s life and career have been the subjects of multiple biographies, some superficial, others the product of prodigious research, and have inspired a stage play by a Pulitzer Prize-winning playwright. This is due in part to the notoriety engendered by the much publicized Malmédy massacre, the worst atrocity committed by Nazi Germany against U.S. forces, and the war crimes trial that followed, the most controversial of the many trials conducted by the United States. But it is also the outgrowth of Peiper’s personality, one that some people who came in contact with him including, ironically, Americans, found appealing. He was intelligent and well-read, good-looking (a dead-ringer for the actor Ray Milland, one person who met him thought), and fluent in English, a vital advantage in his interactions with largely monolingual Americans. His mysterious death in a remote French village early on the morning of Bastille Day, 1976, has served to further stimulate public interest in Peiper
Dexmedetomidine as an Adjunct Therapy to Neuraxial Anesthesia in Labor and Delivery
Get PDFIn 2011, the Centers for Disease Control (CDC) declared the opioid crisis an epidemic, and in 2017 it was declared a public health emergency. In labor and delivery, neuraxial anesthesia has been used for over a hundred years to provide pain relief for parturients. Although many alternatives have been studied, opioids are the most frequently used local anesthetic adjuvants, and their use in neuraxial blocks has evolved over the last 50 years (Swain et al., 2017). While neuraxial opioids have proven to be an effective adjunct for pain relief, they are associated with undesirable side effects as well as the exposure of the patient to the opioid itself. With the push for opioid-free techniques, researchers have searched for non-narcotic alternatives that can provide the same benefits as their narcotic counterparts. Dexmedetomidine (DEX) is an opioid-free, selective alpha-2 agonist that has been shown to be equal to, and in most cases, superior to opioid additives in neuraxial blockade (Qi et al., 2016).
This project aimed to educate and institute a protocol for anesthesia providers in the Obstetric department of a suburban hospital in Bradenton, FL about using neuraxial Dexmedetomidine as an opioid-free replacement for patients during the entire labor process. The sample group was given a pre-test to assess their knowledge and experience with neuraxial DEX and their initial feeling on implementing DEX into their practice. Upon completing the pre-test, the group was given a PowerPoint presentation and all questions were answered satisfactorily. Approximately two weeks after training, the sample group was given a post-test to assess knowledge retention and willingness to implement DEX into their current practice. This quality improvement project successfully provided education for the present and future anesthesia providers that participated in it. This was evidenced by the combined 64% increase in knowledge of the use of this adjunct of the licensed providers and the 87% increase in the student’s knowledge. In addition, and perhaps more importantly, roughly 32% more licensed providers replied that they were more likely to incorporate the use of this adjunct into their practice. This knowledge and willingness to implement change will benefit the anesthesia providers, nursing staff, physician staff, and, most importantly, the patients
The Effectiveness of Using the Anatomage Table as a Learning Adjunct to Peripheral Nerve Blocks Among Student Registered Nurse Anesthetists
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In anesthesia programs across the country, learning advanced level human anatomy and physiology concepts provides a large foundation for which skills used in clinical application are learned. Student registered nurse anesthetists (SRNAs) are clinically trained to perform a variety of invasive procedures in practice including peripheral nerve blocks (PNBs). This project aimed to implement a supplemental, hands-on learning activity to improve overall PNB education, ultimately improving patient care and safety. A series of guided lessons were created to help the students walk through the anatomy of PNBs utilizing the Anatomage table (AT). SRNAs attended a workshop where they went through these lessons and then applied their knowledge to ultrasound images. An anonymous survey was given to students prior to and after the workshop to assess their confidence with the blocks. The pre-survey revealed that only 24.1% of students were confident in completing a PNB with guidance. Student confidence rose to 82.8% after attending the AT workshop. Incorporating the AT in an ultrasound guided PNB lab improved knowledge of the anatomy associated with each block. Having resources, such as these, available to SRNAs will lead to the production of strong nurse anesthesiologists, proficient in regional anesthesia
Establishing a Neonatal Peripherally Inserted Central Catheter (PICC) Team
Get PDFInfants admitted to the neonatal intensive care unit (NICU) have a plethora of diagnoses, including prematurity and newborns with genetic, neurological, surgical, and cardiac problems. The nature of these disease processes usually precludes enteral feedings and providing the infant with appropriate nutrition and hydration is a priority. This requires central venous access and peripherally inserted central catheter (PICC) placement allows for a reliable route of administration for intravenous nutrition and medications. The purpose of this project was to develop a nurse-led neonatal PICC team to provide timely placement of PICC lines while maintaining cost-effectiveness and maintaining a minimal number of adverse events, such as central-line associated bloodstream infections (CLABSIs). A nurse-led neonatal PICC line team was created at one local Midwestern Level III NICU. Five-day shift and five-night shift NICU registered nurses (RNs) were recruited to join the neonatal PICC line team. This allowed the team to provide 24-hour PICC line coverage year-round. The initial qualifications for membership were 4+ years of Level III NICU experience, expert peripheral IV insertion skills, excellent communication and organizational skills, and flexibility of shift scheduling. Results showed a decrease in the length of time between PICC line consultation to successful PICC line placement and a decrease in the number of peripheral IV attempts between the time of PICC line consultation to successful PICC line placement without an increase in adverse patient events while maintaining cost-effectiveness. This project can be utilized among other nursing units to establish and maintain a successful PICC line team to improve patient outcomes without increasing cost or adverse patient events
“Piecemeal” Advocacy, Radical Accomplishments: Adding Normatizing to the Advocacy Toolbox
No full textWomen’s rights advocates in Iowa successfully got state laws adopted in the late 1980s and in 2009 requiring gender balance on state and local boards and commissions, the only such laws in the USA. Through interview and archival methods, this paper uses a critical juncture framework to unveil how this was accomplished in part through a strategy underexplored in academic and practitioner literature—deradicalizing an issue through a series of “piecemeal” efforts. Small less controversial changes can build up to alter the status quo, making room for changes previously thought unaccomplishable. This study brings normatizing—the process of incrementally institutionalizing new norms—forward as a socialization strategy for social movement actors to intentionally consider employing in situations they encounter where political will on an issue is substantially lacking
Lessons from a Forgotten Fuel: Assessing the Long History of Alcohol Fuel Advocacy and Use in the United States
Get PDFDebates over biofuels, especially ethanol and biodiesel, in the twenty-first century rarely consider the long history of producing and consuming biofuels in the United States. This article assesses that long history of industrially produced biofuels in the United States. First, the article periodizes a century and a half of biofuels into six distinct eras: (1) the camphene era (1830s-1860s) when alcohol was used for illumination, (2) the early automobile era (1900-1920) when alcohol was pitted against gasoline in internal combustion engines, (3) the rural development era (1920s-1930s) when alcohol fuels were promoted to help struggling farmers, (4) the energy crisis era (1970s-1980s) when alcohol fuels were used to extend tight fuel supplies, (5) the environmentalism era (1990s-2001) when alcohol fuels were promoted as cleaner than gasoline, and (6) the energy security era (2001-present) when alcohol fuels became a tool to achieve energy security. Second, the article argues that biofuels’ history in the United States illustrates broader themes in the history (and likely future) of renewable energy, such as the role of regional politics in shaping renewable energy systems, the emergence of sacrifice zones for renewable fuel production, and the influence of national culture on renewable energy policy
Calmodulin binding to the dehydrogenase domain of NADPH oxidase 5 alters its oligomeric state
Get PDFSuperoxide generated by NADPH Oxidase 5 (Nox5) is regulated by Ca2+ through the interaction of its self-contained Ca2+ binding domain and dehydrogenase domain (DH). Recently, calmodulin (CaM) has been reported to enhance the Ca2+ sensitivity of Nox5 by binding to the CaM-binding domain sequence (CMBD), in which the interaction between CaM and Nox5 is largely unclear. Here, we used the CMBD peptide and truncated DH constructs, and separately studied their interaction with CaM by fluorescence, calorimetry, and dynamic light scattering. Our results revealed that each half-domain of CaM binds one CMBD peptide with a binding constant near 106 M-1 and a binding enthalpy change of −3.81 kcal/mol, consistent with an extended 1:2 CaM:CMBD structure. However, the recombinant truncated DH proteins exist as oligomers, possibly trimer and tetramer. The oligomeric states are concentration and salt dependent. CaM binding appears to stabilize the DH dimer complexed with CaM. The thermodynamics of CaM binding to the DH is comparable to the peptide-based study except that the near unity binding stoichiometry and a large conformational change were observed. Our result suggests that the oligomeric states of Nox5, mediated by its DH domain and CaM, may be important for its superoxide-generating activity
Implementation of Depression Screening in a Nursing Home
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Background/Introduction
Unidentified and untreated depression among nursing home residents leads to poor quality-of-life and substantial healthcare dollars are utilized for care management. Use of validated instruments and routine screening provides opportunity for early detection and treatment.
Purpose
The purpose of this project was to educate employees of a nursing home on the use of the Geriatric Depression Screening (GDS) tool, implement it on two units of the nursing home, and evaluate the feasibility and acceptability of this quality improvement project.
Method
An educational presentation was delivered to introduce the implementation plan, GDS screening tool, and protocol for data collection. Return demonstration was utilized to assess understanding of training. A 10-item evaluation tool was developed to understand staff experiences during the implementation.
Results
The return demonstration revealed increased understanding for the nurses on identification of symptoms of depression. Use of the GDS was deemed overwhelmingly feasible and acceptable by staff.
Limitations
Limitations of this project are high staff turnover rate and increased nurses’ workload due to COVID protocols, requiring frequent re-education.
Implication to Practice/Conclusion
Positive patient screening throughout this project led to early and appropriate interventions to manage symptoms and improved quality-of-life. It also led to routine screening of this nursing home residents on admission and every 6months. Early detection of depression symptoms through caregiver knowledge can provide timely treatment and improved quality of life
Improving Staff Education on Lung Cancer Screening at the Illinois Correctional Facilities for the Justice-Involved Individuals
Get PDFJustice-involved individuals are at an increased risk of developing chronic health conditions, including lung cancer. Literature supports the practice of using an annual low-dose CT scan to screen for lung cancer. Illinois Correctional Facilities lacked a lung cancer screening protocol for justice-involved individuals. Lung cancer screening guidelines were approved for the facilities, however, the time frame for implementation was unclear. This DNP project focused on evidenced based guidelines for lung cancer screening with education tools for staff members to prepare them for implementation. Staff was presented with a pre-test, PowerPoint presentation, and a post-test to evaluate lung cancer screening knowledge. Our educational goal for improvement was set at a 25% increase from pre-test to post-test. There was a 27% increase in correct response rate for lung cancer screening awareness questions after watching the presentation, implying this was a successful strategy for improvement of knowledge. On the post-test all staff members agreed at a 100% to feeling confident in applying the U. S. Preventive Services Task Force (USPSTF) guidelines for lung cancer screening for justice-involved individuals. For future projects with correctional facilities, it would be beneficial to coordinate efforts with the director who supervises targeted staff members. In addition, having a hands-on approach by presenting the PowerPoint and pre/post-tests in person would potentially increase participation in the project
Difficult Labor Epidural: Intrathecal Catheter Management
Get PDFLabor epidural analgesia is the most common method used to control pain associated with labor and vaginal delivery in the United States. However, the epidural catheter placement can cause accidental dural puncture in about 1 to 6% of laboring patients. Initiation of continuous intrathecal analgesia provides a good alternative to another attempt of epidural placement in certain types of the laboring population. While other countries have published referral guidelines of managing accidental dural puncture, the United States lacks such practice standards. The application of Accidental Dural Puncture Management with Intrathecal Catheter (ADPMIC) guidelines, used in other countries for difficult epidural placement in parturients, have offered effective and safe analgesia and anesthesia with fewer complications, and better patient outcomes. The anesthesia providers at the host institution had limited understanding of continuous intrathecal catheter’s benefits and uses. The purpose of this project was to educate anesthesia providers on ADPMIC principles and introduce a management protocol for laboring patients customized to host facility resources. An educational PowerPoint presentation was used to lecture on the ADPMIC principles and introduce the evidence-based protocol. A post-presentation survey was used to assess protocol understanding and willingness towards implementation. Survey results verified providers improved comprehension of the ADPMIC principles. Additionally, anesthesia providers expressed a high intent to implement the protocol into their practice. The immediate impact of the project was appreciated by provider adoption of the standardized reference tool for a visual and modifiable step-by-step when anesthesia providers encounter difficult epidural placement in laboring patients