288 research outputs found
The Effect of Evaluating a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents
No full textThe Effect of a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents
by
Denise Eileen Jarboe
MSN, Walden University, 2010
BS, University of Maryland, 1981
Project Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
February 2015
Nursing homes (NH) in the 21st century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status that may lead to an avoidable or unnecessary hospital transfer. The purpose of this DNP project was to evaluate the impact of a quality assurance performance improvement (QAPI) initiative implementing the INTERACTTM (interventions to reduce acute care transfers) SBAR (situation, background, assessment/appearance, recommendation) communication tool in a skilled NH setting. The Synergy Model, which posits that optimal patient outcomes are possible when nurse competency is matched or synergized with patient care needs, provided the conceptual framework for this project. To evaluate the effect of the program, resident hospital transfer events groups before and after SBAR utilization (n = 295) were analyzed using a dependent t test to determine if significant differences existed in the groups in overall number of transfers, clinical condition categories, and those leading to an inpatient hospitalization. Although analysis of the data did not demonstrate significant decreases in resident transfer events, the results did provide valuable baseline information for future studies. This project contributed to social change by evaluating communication among care providers in a skilled NH setting, establishing baseline information and identifying the need for future projects. This information is vital for determining which resident transfers to the hospital are avoidable and for developing future programs addressing this practice issue
Strategic nutrient sourcing for biomanufacturing intensification
No full textThe successful design of economically viable bioprocesses can help to abate global dependence on petroleum, increase supply chain resilience, and add value to agriculture. Specifically, bioprocessing provides the opportunity to replace petrochemical production methods with biological methods and to develop novel bioproducts. Even though a vast range of chemicals can be biomanufactured, the constraints on economic viability, especially while competing with petrochemicals, are severe. There have been extensive gains in our ability to engineer microbes for improved production metrics and utilization of target carbon sources. The impact of growth medium composition on process cost and organism performance receives less attention in the literature than organism engineering efforts, with media optimization often being performed in proprietary settings. The widespread use of corn steep liquor as a nutrient source demonstrates the viability and importance of “waste” streams in biomanufacturing. There are other promising waste streams that can be used to increase the sustainability of biomanufacturing, such as the use of urea instead of fossil fuel-intensive ammonia and the use of struvite instead of contributing to the depletion of phosphate reserves. In this review, we discuss several process-specific optimizations of micronutrients that increased product titers by twofold or more. This practice of deliberate and thoughtful sourcing and adjustment of nutrients can substantially impact process metrics. Yet the mechanisms are rarely explored, making it difficult to generalize the results to other processes. In this review, we will discuss examples of nutrient sourcing and adjustment as a means of process improvement.This article is published as Kimia Noroozi, Laura R Jarboe, Strategic nutrient sourcing for biomanufacturing intensification, Journal of Industrial Microbiology and Biotechnology, Volume 50, Issue 1, 2023, kuad011, https://doi.org/10.1093/jimb/kuad011. © The Author(s) 2023This is an Open Access article
distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited
Sustained Spheromak Physics Experiment.
No full textThe Sustained Spheromak Physics Experiment, SSPX, will study spheromak physics with particular attention to energy confinement and magnetic fluctuations in a spheromak sustained by electrostatic helicity injection. In order to operate in a low collisionality mode, requiring T e > 100 eV, vacuum techniques developed for tokamaks will be applied, and a divertor will be used for the first time in a spheromak. The discharge will operate for pulse lengths of several milliseconds, long compared to the time to establish a steady-state equilibrium but short compared to the L/R time of the flux conserver. The spheromak and helicity injector ("gun") are closely coupled, as shown by an ideal MHD model with force-free injector and edge plasmas. The current from the gun passes along the symmetry axis of the spheromak, and the resulting toroidal magnetic field causes the safety factor, q , to diverge on the separatrix. The q -profile depends on the ratio of the injector current to spheromak current and on the magnetic flux coupling the injector to the spheromak. New diagnostics include magnetic field measurements by a reflectometer operating in combined O- and X-modes and by a transient internal probe (TIP)
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Observation of Persistent Edge Current Driven by Coaxial Helicity Injection (CHI)
No full textCoaxial Helicity Injection, CHI, has been used on the National Spherical Torus Experiment (NSTX) [M. Ono et al., Nucl. Fusion 40 (2000) 557], the Helicity Injected Torus (HIT) [B.A. Nelson et al., Phys. Rev. Lett. 72 (1994) 3666] and HIT-II [T.R. Jarboe et al., Phys. Plasmas 5 (1998) 1807] to initiate plasma and to drive up to 400 kA of toroidal current. On HIT-II, CHI initiated discharges have been successfully coupled to ohmic sustainment [R. Raman et al., Phys. Plasmas 11 (2004) 2565]. This paper presents the first results on the use of CHI to demonstrate the persistence of edge current drive in a preestablished single-null diverted inductive discharge. Edge current drive has the potential to improve plasma stability limits [J.E. Menard et al., Nucl. Fusion 37 (1997) 595]. While most current drive methods drive current in the interior of the plasma, CHI is well suited for driving current in the edge plasma
Promoting microbial utilization of phenolic substrates from bio-oil
No full textThe economic viability of the biorefinery concept is limited by the valorization of lignin. One possible method of lignin valorization is biological upgrading with aromatic-catabolic microbes. In conjunction, lignin monomers can be produced by fast pyrolysis and fractionation. However, biological upgrading of these lignin monomers is limited by low water solubility. Here, we address the problem of low water solubility with an emulsifier blend containing approximately 70 wt% Tween® 20 and 30 wt% Span® 80. Pseudomonas putida KT2440 grew to an optical density (OD600) of 1.0 ± 0.2 when supplied with 1.6 wt% emulsified phenolic monomer-rich product produced by fast pyrolysis of red oak using an emulsifier dose of 0.076 ± 0.002 g emulsifier blend per g of phenolic monomer-rich product. This approach partially mitigated the toxicity of the model phenolic monomer p-coumarate to the microbe, but not benzoate or vanillin. This study provides a proof of concept that processing of biomass-derived phenolics to increase aqueous availability can enhance microbial utilization.This is a manuscript of an article published as Davis, Kirsten, Marjorie R. Rover, Davinia Salvachúa, Ryan G. Smith, Gregg T. Beckham, Zhiyou Wen, Robert C. Brown, and Laura R. Jarboe. "Promoting microbial utilization of phenolic substrates from bio-oil." Journal of Industrial Microbiology & Biotechnology (2019). DOI: 10.1007/s10295-019-02208-z. Posted with permission.</p
Damage to the microbial cell membrane during pyrolytic sugar utilization and strategies for increasing resistance
No full textLignocellulosic biomass is an appealing feedstock for the production of biorenewable fuels and chemicals, and thermochemical processing is a promising method for depolymerizing it into sugars. However, trace compounds in this pyrolytic sugar syrup are inhibitory to microbial biocatalysts. This study demonstrates that hydrophobic inhibitors damage the cell membrane of ethanologenic Escherichia coli KO11+lgk. Adaptive evolution was employed to identify design strategies for improving pyrolytic sugar tolerance and utilization. Characterization of the resulting evolved strain indicates that increased resistance to the membrane-damaging effects of the pyrolytic sugars can be attributed to a glutamine to leucine mutation at position 29 of carbon storage regulator CsrA. This single amino acid change is sufficient for decreasing EPS protein production and increasing membrane integrity when exposed to pyrolytic sugars.This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Industrial Microbiology and Biotechnology following peer review. The version of record: Jin, Tao, Marjorie R. Rover, Elspeth M. Petersen, Zhanyou Chi, Ryan G. Smith, Robert C. Brown, Zhiyou Wen, and Laura R. Jarboe. "Damage to the microbial cell membrane during pyrolytic sugar utilization and strategies for increasing resistance." Journal of Industrial Microbiology and Biotechnology 44, no. 9 (2017): 1279-1292 is available online at DOI: 10.1007/s10295-017-1958-4. Copyright 2017 Society for Industrial Microbiology and Biotechnology. Posted with permission
Production of biorenewable styrene: utilization of biomass-derived sugars and insights into toxicity
No full textFermentative production of styrene from glucose has been previously demonstrated in Escherichia coli. Here, we demonstrate the production of styrene from the sugars derived from lignocellulosic biomass depolymerized by fast pyrolysis. A previously engineered styrene-producing strain was further engineered for utilization of the anhydrosugar levoglucosan via expression of levoglucosan kinase. The resulting strain produced 240 ± 3 mg L−1 styrene from pure levoglucosan, similar to the 251 ± 3 mg L−1 produced from glucose. When provided at a concentration of 5 g L−1, pyrolytic sugars supported styrene production at titers similar to those from pure sugars, demonstrating the feasibility of producing this important industrial chemical from biomass-derived sugars. However, the toxicity of contaminant compounds in the biomass-derived sugars and styrene itself limit further gains in production. Styrene toxicity is generally believed to be due to membrane damage. Contrary to this prevailing wisdom, our quantitative assessment during challenge with up to 200 mg L−1 of exogenously provided styrene showed little change in membrane integrity; membrane disruption was observed only during styrene production. Membrane fluidity was also quantified during styrene production, but no changes were observed relative to the non-producing control strain. This observation that styrene production is much more damaging to the membrane integrity than challenge with exogenously supplied styrene provides insight into the mechanism of styrene toxicity and emphasizes the importance of verifying proposed toxicity mechanisms during production instead of relying upon results obtained during exogenous challenge.This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of Industrial Microbiology and Biotechnology following peer review. The version of record: Lian, Jieni, Rebekah McKenna, Marjorie R. Rover, David R. Nielsen, Zhiyou Wen, and Laura R. Jarboe. "Production of biorenewable styrene: utilization of biomass-derived sugars and insights into toxicity." Journal of Industrial Microbiology and Biotechnology 43, no. 5 (2016): 595-604 is available online at DOI: 10.1007/s10295-016-1734-x. Copyright 2016 Society for Industrial Microbiology and Biotechnology. Posted with permission
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