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Traces of the invisible: how an alternative reading of The Sleeping Beauty fashioned a bookwork heightening awareness of the role of the anesthetist
No full textThis article discusses a Leverhulme residency undertaken by the author Julie Brixey-Williams in 2003-4 at the Association of Anaesthetists of Great Britain and Ireland. Notions of medical visibility were explored through practice-led investigations under the umbrella title Traces of the Invisible, that concentrated on making concrete, visible responses to the hidden or intangible elements of the anesthetist’s working life, in areas such as sleep, breath, pain and genetic markers. Rosebud is a unique nine-foot concertina bookwork created after reading the entire story of The Sleeping Beauty into an anesthetic machine. This essay expands upon the concepts and material responses that led to the making of the book, with particular reference to how the book’s structure forms a relationship to language and the body-as-site, whilst operating as a sculptural object that raises the visibility of the anesthetic profession. Fairy tales and their telling, including stories of enchanted sleep, transformational qualities, magical languages and shaman healers, will be examined alongside
Determining design freedom of linear feedback control systems
No full text“The problem confronted in this thesis is to develop a method or procedure to be used in determining the amount of design freedom that is available in any given linear feedback control system by working with the signal flow-graph representation of the system.
Literature was reviewed that deals with basic signal flow-graph theory and degrees of design freedom. Signal- flow-graph theory that forms a foundation for the development is presented.
The development consists of starting with an essential signal-flow graph of order one. The sensitivity and transmittance functions are written for this essential graph in terms of graph symbols; then these functional relationships are solved to give each graph symbol in terms of graph functions.
A procedure is written for the use of the derived equations in determining design freedom and examples are used to illustrate the procedure. Discussed briefly is the possibility of applying this procedure to systems represented by signal-flow graphs of order greater than one”--Abstract, page ii
College of Pharmacy, University of Utah, Class of 1992. "Senior Banquet" Invitation
No full textCollege of Pharmacy, University of Utah, Class of 1992. "40th Annual Senior Banquet" Invitation. Tuesday, May 26, 1992, 6:30 pm. Dinner. Introductions: Dwight S. Fullerton, Dean. Preceptor of the Year Award: Mr. Kevin Flanary, Syntex Laboratories, Inc. Adjournment. Guest Sponsors: Bergen Brunswig Drug Co., McKesson Drug Co., Whitmire Distribution Corporation. Pharmacy Graduates 1992: Ahlmer, Pam; Anthony, Layne; Barton, Robert; Bassek, Roland; Bjerregaard, Barbara; Brixey, Lanita; Catalano, Neal; Cole, DeAnn; Cole, DeOnn; Compagni, Kim; DeMass, Kevin; Fitzgerald, Leonard; Gudmundson, Dave; Hong, Melissa; Johnson, Joseph; Kato, Troy; Keindl, Linda; Norr, Grace; Pola, Ken; Rae, Gary; Rae, Kathryn; Ruble, Jim; Sadri-Naini, Mehrdad; Silverstein, Jeff; Stipetic, Marcel; Szymanski, Richard; Tanner, Danni; Tanner, Donna; Thompson, Carie; Van De Walle, Kim; Verde, Angela; Wall, Geoffrey; Warren, Brian; White, Michelle; Wride, Richard; Zalupski, Jr., Rick
Right time in medication administration: A multifaceted concept
No full textPurpose: The medication administration process is a five-step procedure entailing prescribing, transcribing, dispensing, administering, and monitoring. Medication administration involves giving a pharmacological agent, such as a drug, to a patient or client. Within medication administration the patient expects the right medication, in the right dose, to be at the right time, and by the right route. ‘Right time , which is clearly identified as an important component of the medication administration process, should therefore be clearly defined as well achievable. ‘Right time also implies a measurable period of time. The literature does not clearly define ‘right time instead defining through linking to, for example, a prescribing provider s order or the most recent administration. The purpose of this study was to review the literature to determine themes, trends, and definitions of ‘right time of medication administration.
Methods: A retrospective review of the literature was conducted to identify themes and trends of ‘right time of medication administration.
Results: A specific definition of ‘right time was not readily discovered in the literature. The following trends were identified from the literature. For example, ‘right time is coupled with an exact time such as an hour for administration (e.g., at 0600). Moreover, ‘right time is intimately related to frequency. For example, twice a day at 0900 and 1700. ‘Right time may also be coupled with a range in hours. For instance, every two hours or every six hours. What is more, ‘Right time can be extended to a seasonal event. For example, the ‘right time to receive the flu vaccine during the flu season. Right time is teamed with vital signs. For example, administer acetaminophen every 6 hours as needed for temperature greater than 100 degree F. ‘Right time is also coupled with laboratory values. Administer Warfarin 5 mg for INR \u3c 1.5. Additionally ‘right time is frequently denoted with a specific parameter such as with food or without food. These attributes should ultimately be based on drug action, distribution, absorption, metabolism, and excretion.
Conclusion: A definition for ‘right time medication administration needs to be explicitly stated. This research study indicates ‘right time is a multifaceted concept without a clear and precise definition. This research begins development of a taxonomy of ‘right time drug administration
Integrated redox sensor and effector functions for tetrahydrobiopterin- and glutathionylation-dependent endothelial nitric-oxide synthase uncoupling.
No full textEndothelial nitric-oxide synthase (eNOS) is a critical regulator of vascular homeostasis by generation of NO that is dependent on the cofactor tetrahydrobiopterin (BH4). When BH4 availability is limiting, eNOS becomes "uncoupled," resulting in superoxide production in place of NO. Recent evidence suggests that eNOS uncoupling can also be induced by S-glutathionylation, although the functional relationships between BH4 and S-glutathionylation remain unknown. To address a possible role for BH4 in S-glutathionylation-induced eNOS uncoupling, we expressed either WT or mutant eNOS rendered resistant to S-glutathionylation in cells with Tet-regulated expression of human GTP cyclohydrolase I to regulate intracellular BH4 availability. We reveal that S-glutathionylation of eNOS, by exposure to either 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) or glutathione reductase-specific siRNA, results in diminished NO production and elevated eNOS-derived superoxide production, along with a concomitant reduction in BH4 levels and BH4:7,8-dihydrobiopterin ratio. In eNOS uncoupling induced by BH4 deficiency, BCNU exposure further exacerbates superoxide production, BH4 oxidation, and eNOS activity. Following mutation of C908S, BCNU-induced eNOS uncoupling and BH4 oxidation are abolished, whereas uncoupling induced by BH4 deficiency was preserved. Furthermore, BH4 deficiency alone is alone sufficient to reduce intracellular GSH:GSSG ratio and cause eNOS S-glutathionylation. These data provide the first evidence that BH4 deficiency- and S-glutathionylation-induced mechanisms of eNOS uncoupling, although mechanistically distinct, are functionally related. We propose that uncoupling of eNOS by S-glutathionylation- or by BH4-dependent mechanisms exemplifies eNOS as an integrated redox "hub" linking upstream redox-sensitive effects of BH4 and glutathione with redox-dependent targets and pathways that lie downstream of eNOS
Pictorial Review of Fibrotic Interstitial Lung Disease on High Resolution CT Scan and Updated Classification.
No full textTOPIC IMPORTANCE: Given the recently expanded approval of antifibrotics for various fibrotic interstitial lung diseases (ILDs), early and correct recognition of these diseases is imperative for physicians. Because high-resolution chest CT scan forms the backbone of diagnosis for ILD, this review will discuss evidence-based imaging findings of key fibrotic ILDs and an approach for differentiating these diseases.
REVIEW FINDINGS: (1) Imaging findings of nonspecific interstitial pneumonia may evolve over time and become indistinguishable from usual interstitial pneumonia. Therefore, if remote imaging can be reviewed, this would increase the likelihood of an accurate imaging diagnosis, particularly if findings appear to represent a usual interstitial pneumonia pattern on the recent examination. (2) Given the difficulty and lack of objectivity in classifying patients with hypersensitivity pneumonitis into acute, subacute, and chronic categories and that prognosis depends primarily on presence or absence of fibrosis, the new set of guidelines released in 2020 categorizes patients with hypersensitivity pneumonitis as either nonfibrotic (purely inflammatory) or fibrotic (either purely fibrotic or mixed fibrotic/inflammatory) based on imaging and/or histologic findings, and the prior temporal terms are no longer used. (3) Interstitial lung abnormalities are incidental CT scan findings that may suggest early ILD in patients without clinical suspicion for ILD. Patients with high-risk features should undergo clinical evaluation for ILD and be actively monitored for disease progression.
SUMMARY: Fibrotic ILD on high-resolution chest CT scan is a complex topic, but with use of an evidence-based analysis and algorithm as provided in this article, the probability of a correct imaging diagnosis increases
Contributing factors to errors in Swedish emergency departments
No full textObjective: The Emergency Department (ED) is a complex and dynamic environment, often resulting in a somewhat uncontrolled and unpredictable workload. Contributing factors to errors in health care and in the ED are largely related to communication breakdowns. Moreover, the ED work environment is predisposed to multitasking, overcrowding and interruptions. These factors are assumed to have a negative impact on patient safety. Reported errors from care providers are mainly related to diagnostic procedures in Swedish EDs. However, there is a lack of knowledge and national oversight regarding contributing factors. The aim of this study was therefore to describe contributing factors in regards to errors occurring in Swedish EDs. Method: Descriptive design based on registry data from the Lex Maria database of the Swedish National Board of Health and Welfare. Results: The results indicate that factors contributing to errors in Swedish EDs are multifactorial in nature. The most common contributing factor was human error followed by factors in the local ED environment and teamwork failure. Conclusion: Factors contributing to ED errors were multifactorial and included both organizational and teamwork failure in which human error was implicated. To reduce errors, further research is needed to develop methods that disclose latent working conditions such as high workload and interruptions. Patient safety research needs to include understanding of human behaviour in complex organizational systems and the impact of working conditions on patient safety and quality of care.</p
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