bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Uses (and Potential Misuses) of Facebook: An Online Survey in Physiotherapy
Authors: Laliberté Maude , Beaulieu-Poulin Camille , Campeau Larrivée Alexandre , Charbonneau Maude , Samson Émilie , Ehrmann Feldman Debbie
Published: January 2016

Purpose: In recent years, the use of social media such as Facebook has become extremely popular and widespread in our society. Among users are health care professionals, who must develop ways to extend their professionalism online. Before issuing formal guidelines, policies, or recommendations to guide online behaviours, there is a need to know to what extent Facebook influences the professional life of physiotherapy professionals. Our goal was to explore knowledge and behaviour that physiotherapists and physical rehabilitation therapists practicing in Quebec have of Facebook. Method: We used an empirical cross-sectional online survey design (n=322, response rate 4.5%). Results: The results showed that 84.3% of physiotherapy professionals had a Facebook account. Almost all had colleagues or former colleagues as Facebook friends, 21% had patients as friends, and 27% had employers as friends. More than a third of workplaces had clinic pages with information intended for the public. Regarding workplace Facebook policies, 37.3% said that there was no policy and another 41.6% were not aware whether there was one or not. Conclusion: There appears to be a need to establish guidelines regarding the use of social media for physiotherapy professionals to ensure maintenance of professionalism and ethical conduct.
Alternative Source of Climate Data for Mechanistic–Empirical Pavement Performance Prediction
Authors: Schwartz Charles W. , Forman Barton A. , Leininger Christopher W.
Published: January 2016

The AASHTO Mechanistic–Empirical Pavement Design Guide (MEPDG) and accompanying Pavement ME Design software emphasize the influence of climate on pavement performance. Several hundred weather history files from ground-based operating weather stations (OWSs) are provided with the MEPDG software. An alternate climate data source, the Modern Era Retrospective–Analysis for Research and Application (MERRA) product from the National Aeronautics and Space Administration, is evaluated here. MERRA is a global climate reanalysis procedure that combines computed model fields with ocean-, airborne-, and satellite-based observations. MERRA has the advantage of uniform worldwide spatial coverage at an approximately 0.5° by 0.67° (latitude and longitude) horizontal resolution, continuous hourly time series from 1979 to the present, and a high level of data quality control. Comprehensive statistical comparisons between MERRA climate data and those from various conventional ground-based sources are presented. Comparisons of MEPDG performance predictions with MEPDG OWS and MERRA climate data for 20 locations distributed across the contiguous United States are also summarized. The statistical and performance prediction comparisons support the conclusion that MERRA is an acceptable and advantageous source for climate data that can be used in place of conventional ground-based OWSs.
Phenotypic characterization and production potentials of Nageswari duck in Bangladesh
Authors: Morduzzaman M , Bhuiyan AKFH , Rana M , Islam MR , Bhuiyan MSA
Published: January 2016

The present study was conducted to know the morphology, morphometry, production and reproduction potentialities of Nageswari duck, an indigenous duck genetic resource of Bangladesh. Data on 58 representative adult Nageswari ducks were included for morphological study from 24 duck owners and two government organizations having Nageswari duck flocks while 468 individuals were considered for the traits of productive and reproductive performances. Information was collected by using a structured questionnaire through personal interaction, on spot recording and direct phenotypic measurements in five different regions of Bangladesh. Black plumage color with white stripe extended from neck to breast make unique features of Nageswari duck compared to other indigenous ducks. Morphometric measurements on adult live weight, body length, head diameter, bill length, neck length, shank length, wing length, massiveness and condition index in male and female were found to be 1.66±0.07 and 1.51±0.05 kg, 26.27±0.57 and 23.79±0.39 cm, 3.49±0.02 and 3.36±0.04 cm, 5.87±0.09 and 5.54±0.07 cm, 23.49±0.58 and 21.59±0.49 cm, 5.76±0.12 and 5.16±0.11 cm, 24.58±0.49 and 21.99±0.53 cm, 6.33±0.28 and 6.39±0.22, and 6.72±0.23 and 6.93±0.23 respectively. Age at first egg of Nageswari duck was found to be 168.48±3.53 days. Total number of eggs laid per year averaged 173.63±3.39 and peak production was found in 29.46±0.19 weeks. The average egg weight was estimated to be 67.32±0.82 g and characteristic bluish tinge of egg color was observed. Breed specific characteristic features and production profiles were observed in this study. The present study provided some baseline information on Nageswari duck of Bangladesh which could be useful for genetic characterization, conservation and future improvement programs in Bangladesh.Bang. J. Anim. Sci. 2015. 44(2): 92-99
Effect of pellet and mash feeding on the performance of growing rabbit
Authors: Rahman MZ , Reza A , Siddiki MA , Hossain MI , Asaduzzaman M , Rahman MM
Published: January 2016

The present study was undertaken to know the effect of pellet and mash feeding on nutrient digestibility, growth performance and carcass weight of growing rabbits. For this purpose fifteen crossbred New-Zealand white rabbit were selected for conducting the experiment. The Average ages of these experimental rabbits were 1.5 to 2.0 months. All the rabbits were housed in Quonset style cages. Animals were distributed to mash (T1), pellet (T2) and mixture of pellet and mash (T3) groups equally with five animals in each group. All the animals were supplied ad libitum green grass. The experiment shows that highest body weight was found from pelleted group. Growth rate of different dietary treatment differ significantly (p<0.05). FCR of different dietary groups did not differ significantly. Carcass weight and dressing yield of rabbits did not differ significantly, but dressing yield was highest for pelleted  group. So the study reveal that, feeding of pelleted diet resulted in higher growth rate, growth velocity, dressing yield, better feed conversion efficiency compared to mash and pellet with mash.Bang. J. Anim. Sci. 2015. 44(2): 100-105
Existing production and marketing system of fodder under Meherpur district as livelihood activity
Authors: Roy BK , Sarker NR , Alam MK , Huque KS
Published: January 2016

An investigation was carried out with the objectives to determine the existing production and marketing system of fodder as a livelihood activity of farmers under Meherpur district. For this, a purposive survey was conducted covering three Upazilas of Meherpur district namely, Meherpur Sadar, Gangni and Mujibnagar. Before conducting the survey, a Focus Group Discussion (FGD) was arranged and it was identified that there were three stakeholders involved under these areas: fodder producers, middlemen and users of fodder. On the basis of the findings of FGD, a survey was conducted through a pre-tested structured questionnaire as per objectives of the survey. Data were collected randomly from 33 Napier producers, 18 middlemen and 64 fodder users. Survey results indicated that, the average number of cattle and goat per household was 2.12 and 3.19, respectively, while on the other hand none of the farmers under the study areas reared sheep. Sharing of major household income implied that, majority of the fodder producers (72.72%) depended on their livelihood on Napier production and about 83.33% middlemen depends their livelihood on fodder marketing. However, the major sources of income of dairy keepers were business (39.06%), fodder production (20.31%) and agriculture (12.50%). The annual total biomass production of Napier per hectare was 314.48 metric tons. About 45% producers sold green Napier grass in the market, 30% supply directly to middlemen and the rest of 25% farmers marketed their produces directly in market and to middlemen. The prices of a bundle of Napier grass were varied from Tk. 3.00-4.00 to 5.00-6.00, respectively during summer and winter. The total cost, gross income and net profits for Napier production were Tk. 2,37,934.00, Tk. 4,71,723.00 and Tk. 2,33,789.00 per hectare per year, respectively. The benefit cost ratio (BCR) for Napier cultivation was 1.98:1. It can be concluded that fodder production and marketing system in Meherpur district is a profitable enterprises and all the stakeholders under this production and marketing system are getting monetary benefits.Bangladesh J. of Livestock Res. 19(1-2): 24-32, Jan-Dec 2012
Effect of genotype and lactation on milk urea nitrogen, blood urea nitrogen and milk composition of dairy cows
Authors: Sarker MSK , Islam MA , Huque KS , Sarker NR , Hossain MM , Bhuiyan AA
Published: January 2016

This study was aimed to evaluate milk urea nitrogen (MUN) of cows considering variations in dietary nutrition, genetic quality and lactation yield which will be helpful to develop practical feeding guidelines for dairy cows based on MUN. A total of forty dairy cows consisting 20 native and 20 crossbred milking cows were selected in Sonaimuri, Noakhali in winter season to know the daily feed availability to cows. Feed, milk and blood samples were collected and analyzed. The dry matter intake of the local and crossbred cows were 2.58 and 2.74 (g/100 kg live weight respectively) and they did not show statistical variation (p<0.05). Metabolizable energy (ME) and protein intake showed significantly higher values in crossbred (85 MJ/day and 815 g/day) compared to local (40 MJ/day and 395 g/day) cows in winter season (p>0.05). Live weight, body condition score and milk yield and MUN varied significantly between genotypes although blood urea nitrogen (BUN) value did not differ significantly. Strong correlation between lactose and protein percentage was observed in both the lactations in local cows. Milk minerals are negatively correlated with protein, SnF and minerals in first lactation whereas moderate to strong relation was observed in second lactation with those parameters. Milk constituents didnt show any difference between local & crossbred cows. Strong correlation between milk protein and lactose with SnF were observed in both local and crossbred cows in first lactation stage. BUN value showed a moderate correlation between milk yields of local cows. The results revealed that genotype and lactation have no effect on BUN although MUN value showed significant difference between local and crossbred cows.Bangladesh J. of Livestock Res. 19(1-2): 74-84, Jan-Dec 2012
Rabbit production under intensive system in rural condition
Authors: Khatun R , Islam MN , Rashid MA , Ahmed S
Published: January 2016

A total 20 (sixteen female and four male) growing rabbits aged 120 days have been distributed at each farmers level in 5 location of Bangladesh; F1 (Dhaka-Pollobi), F2 (Savar-Parbotinagor), F3 (Magura-Boralidhaho), F4 (Magura-Pannandualli), F5 (Magura-Radhanagor) to know the production response and cost effectiveness under intensive in rural condition. The rabbits were reared in their own arrangement. Age of sexual maturity, age of first kidding, percentage of does kidded, gestation period, litter size, weaning period, breeding ratio were not significantly different (P>0.05) among the locations. Feed cost per month was Tk. 903, Tk. 732, Tk. 772, Tk. 1221.96 and Tk. 976 for F1, F2, F3, F4 and F5 respectively for 20 rabbits rearing. Monthly consumption of rabbit meat per family was 4.5kg, 3kg, 2.4 kg, 6.0 kg, in F1, F2, F3, and F5 respectively. Kid mortality (0-10 days) was significantly different (P<0.01) among the locations and this value was recorded 8.47%, 11.11%,12.00%, 8.82% and 13.11% in F1, F2, F3, F4 and F5 respectively. Farmer earned some money by selling their rabbit which was Tk 10200, Tk7600, Tk8400, Tk12400 and Tk7200 /batch and can earn profit around the 49,564; 39,316; 38,536; 62,336 and 35,688 Tk/year in rearing (7batchs/year) 20 rabbit at in F1, F2, F3, F4 and F5, respectively. Rabbit production could be an important micro-livestock component to produce for meeting up extra demand of the country.Bangladesh J. of Livestock Res. 19(1-2): 107-111, Jan-Dec 2012
Epidemiological studies on subclinical mastitis in dairy goats in northern regions of Bangladesh
Authors: Begum MIA , Hossain MS , Ershaduzzaman M , Alam MS
Published: January 2016

A cross sectional study was carried out from June, 2008 to December, 2010 to estimate the prevalence of subclinical mastitis and to determine the responsible bacterial pathogens in lactating dairy goats in northern districts of Bangladesh. A total of 292 goats and 584 udder halves milk samples were screened using California Mastitis Test (CMT). Prevalence of subclinical mastitis at goat level was 56.2% (164/292), and in udder half level it was 33.9% (198/584). The subclinical mastitis prevalence at goat level was high (71.6%) in Jamnapari goats as compared to Black Bengal goats (50.2%), whereas at the udder half level, subclinical mastitis prevalence was 45.1% and 29.6% in Jamnapari and Black Bengal goats, respectively. The pathogens isolated from subclinical mastitic milk samples were coagulase negative Staphylococci, Coliforms, Streptococcus spp., Staphylococcus aureus, Micrococcus spp., Pseudomonas aeruginosa and Bacillus cereus. Among these, the most frequent isolates were coagulase negative Staphylococci (28.8%), Coliforms (22.7%) and Streptococcus spp (15.2%). Out of four potential host related risk factors considered, litter size and body condition of goats were found to influence the prevalence rate of subclinical mastitis in goat significantly (p< 0.05). On the other hand, the subclinical mastitis was very significantly (p=0.0001) associated with the housing system of goats, i.e., goats reared in raised floor had a low subclinical mastitis infection rate (35.8%) as compared to reared in earth floor (62.2%). Antibiogram studies were also performed for the bacterial isolates and Gentamicin was found to be the most effective drug.Bangladesh J. of Livestock Res. 19(1-2): 112-122, Jan-Dec 2012
Wearable Accelerometers in High Performance Jet Aircraft
Authors: Rice G. Merrill , VanBrunt Thomas B. , Snider Dallas H. , Hoyt Robert E.
Published: January 2016

INTRODUCTION: Wearable accelerometers have become ubiquitous in the fields of exercise physiology and ambulatory hospital settings. However, these devices have yet to be validated in extreme operational environments. The objective of this study was to correlate the gravitational
forces (G forces) detected by wearable accelerometers with the G forces detected by high performance aircraft.METHODS: We compared the in-flight G forces detected by the two commercially available portable accelerometers to the F/A-18 Carrier Aircraft Inertial Navigation System
(CAINS-2) during 20 flights performed by the Navy’s Flight Demonstration Squadron (Blue Angels). Postflight questionnaires were also used to assess the perception of distractibility during flight.RESULTS: Of the 20 flights analyzed, 10 complete in-flight comparisons were made,
accounting for 25,700 s of correlation between the CAINS-2 and the two tested accelerometers. Both accelerometers had strong correlations with that of the F/A-18 Gz axis, averaging r = 0.92 and r = 0.93, respectively, over 10 flights. Comparison of both portable accelerometer’s
average vector magnitude to each other yielded an average correlation of r = 0.93. Both accelerometers were found to be minimally distracting.DISCUSSION: These results suggest the use of wearable accelerometers is a valid means of detecting G forces during high performance
aircraft flight. Future studies using this surrogate method of detecting accelerative forces combined with physiological information may yield valuable in-flight normative data that heretofore has been technically difficult to obtain and hence holds the promise of opening the door for a new
golden age of aeromedical research.Rice GM, VanBrunt TB, Snider DH, Hoyt RE. Wearable accelerometers in high performance jet aircraft. Aerosp Med Hum Perform. 2016; 87(2):102–107.
Incidence and Features of Barodontalgia Among Military Divers
Authors: Gunepin Mathieu , Derache Florence , Blatteau Jean-Eric , Nakdimon Idan , Zadik Yehuda
Published: January 2016

OBJECTIVE: Divers are vulnerable to barodontalgia (atmospheric pressure change related dental pain), which may jeopardize diving safety and mission completion. Our aim was to investigate the experience of barodontalgia among western military divers.METHODS: French
Armed Forces diving personnel were asked to answer a structured questionnaire including questions regarding their oral health, diving and career features, and barodontalgia while diving. For analysis, the participants were divided into commando/clearance divers (Group A) and ship divers (Group
B).RESULTS: All the requested 1389 divers agreed to participate in the study (100%) and 1317 divers (94.8%) who fully completed the questionnaire were included in the analysis. Of these 1317 individuals, 96 (7.3%) suffered from at least 1 episode of barodontalgia while diving, with
a total of 119 episodes of barodontalgia. Barodontalgia was more frequent in the upper (62.2%) than the lower dentition (37.8%) (OR = 2.7; 95% CI, 1.6–4.5) and appeared more common during descent (77.3%) than ascent (22.7%) (OR = 11.6; 95% CI, 6.3–31.3). Barodontalgia experience
was higher in divers who have an examination less than once per year (14.5%) in comparison to divers who usually have a dental examination once a year or more (6.3%) (OR = 2.5; 95% CI, 1.5–4.2).DISCUSSION: Barodontalgia mostly appeared in the maxilla and during descent; therefore,
a great role for barosinusitis in the etiology of oral pain while diving may be suggested. The infrequent experience of barodontalgia in divers who routinely visit the dentist once a year or more suggests that the risk of barodontalgia might decrease with the maintenance of a good oral status.Gunepin
M, Derache F, Blatteau J-E, Nakdimon I, Zadik Y. Incidence and features of barodontalgia among military divers. Aerosp Med Hum Perform. 2016; 87(2):137–140.
Professionel identitetsudvikling gennem uddannelse til erhvervsskolelærer i en empirisk undersøgelse på en diplomuddannelse
Authors: Duch Henriette
Published: January 2016

New vocational teachers in Denmark already have an education when they become teachers. They also have several years of work experience. Regardless of educational background and employing college, they have to attend the same course when they are employed at a vocational college. It is mandatory to complete the Diploma of Education in four years. During that course, the teacher is in transition to become a professional vocational teacher. Drawing on theories of identity the aim is to analyse the development of a professional identity. The terms ‘professional identity’, ‘personal identity’ and ‘identity of the profession’ are defined.

The main finding is that vocational teachers develop new ways to act and think. They develop the professional identity in interaction with colleagues and students from other vocational colleges, but the development is individual.

The research project takes a qualitative approach. Four vocational colleges are selected as cases of maximum variations, and focus group interviews are conducted at each college.
Fabrication and characterization of novel multilayered structures by stereocomplexion of poly(D-lactic acid)/poly(L-lactic acid) and self-assembly of polyelectrolytes
Authors: Dellacasa Elena , Zhao Li , Yang Gesheng , Pastorino Laura , Sukhorukov Gleb B
Published: January 2016

The enantiomers poly(D-lactic acid) (PDLA) and poly(L-lactic acid) (PLLA) were alternately adsorbed directly on calcium carbonate (CaCO3) templates and on poly(styrene sulfonate) (PSS) and poly(allylamine hydrochloride) (PAH) multilayer precursors in order to fabricate a novel layer-by-layer (LBL) assembly. A single layer of poly(L-lysine) (PLL) was used as a linker between the (PDLA/PLLA)n stereocomplex and the cores with and without the polymeric (PSS/PAH)n/PLL multilayer precursor (PEM). Nuclear magnetic resonance (NMR) and gel permeation chromatography (GPC) were used to characterize the chemical composition and molecular weight of poly(lactic acid) polymers. Both multilayer structures, with and without polymeric precursor, were firstly fabricated and characterized on planar supports. A quartz crystal microbalance (QCM), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and ellipsometry were used to evaluate the thickness and mass of the multilayers. Then, hollow, spherical microcapsules were obtained by the removal of the CaCO3 sacrificial template. The chemical composition of the obtained microcapsules was confirmed by differential scanning calorimetry (DSC) and wide X-ray diffraction (WXRD) analyses. The microcapsule morphology was evaluated by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) measurements. The experimental results confirm the successful fabrication of this innovative system, and its full biocompatibility makes it worthy of further characterization as a promising drug carrier for sustained release.
Multiple Trespasses Female Israeli Artists Make Uncommissioned Street Art
Authors: Trajtenberg Graciela
Published: January 2016

Multiples transgressions. Le Street art des artistes israéliennes Cet article analyse la façon dont les Israéliennes s’adonnent aux arts de la rue. Elles transgressent non seulement l’évidence de l’appropriation capitaliste du contrôle de l’espace public, mais aussi les frontières normatives des activités interdites aux femmes. Leurs transgressions se fondent sur des stratégies historiquement définies comme féminines, mais aussi en détournant l’ordre masculine dominant.
Puissance, force et musique metal Quand les filles s’approprient les codes de la masculinité
Authors: Turbé Sophie
Published: January 2016

Cet article dresse un portrait des filles fans de metal à travers un goût musical qui participe au modelage de leur image. Comment récupèrent‑elles à leur propre compte les valeurs proposées par le metal telles que la force, la puissance et la violence, traditionnellement encodées comme « masculines » ? L’article analyse le regard féminin sur cette musique et montre comment celles‑ci parviennent, à leur manière, à « brouiller le genre ».
Ce que co-habiter veut dire Fragmentation et recomposition dans les communes rurales (Puisaye‑Forterre)
Authors: Alphandéry Pierre , Sencébé Yannick , Pinton Florence
Published: January 2016

L’objet de cet article est d’appréhender le mouvement de recomposition sociale qui marque actuellement les campagnes françaises en étudiant les modes de cohabitation en Puisaye‑Forterre. Pour construire une grille de lecture des modes de cohabitation, nous avons revisité les travaux qui ont contribué à la construction de la « spécificité » du rural tout en mobilisant d’autres approches à l’heure où la mobilité et le néocapitalisme transforment les campagnes. Nous avons mis cette grille à l’épreuve en menant des enquêtes à l’échelle de la commune où nous avons cherché à saisir aussi bien ce qui relève du domaine du proche et de la singularité des lieux que ce qui appartient au domaine du lointain et des processus généraux.
Charting the Course for a Nursing Online Journal Club: Part II
Authors: Moonan Marilyn , Bukoye Bola , Clapp Alison , Shermont Herminia , Oliveira Joanne O'Sullivan
Published: January 2016

In a pediatric inpatient setting, an interdisciplinary team designed and implemented an online journal club to discuss current nursing trends and research, as well as to foster evidence-based practice. This article is Part II of a two-part series in which the implementation process is described.

J Contin Educ Nurs.
2016;47(1):14–16.
Hemodynamic Clinical Profiles
Authors: Urban Nancie
Published: January 2016

Hemodynamic profiling provides valuable information about cardiac output and its determinants: preload, afterload, and contractility. The direct and derived parameters of these determinants are used by expert critical care nurses in collaboration with medical directives for intervention to enhance clinical assessment, decisionmaking, and evaluation. This article reviews the basic and advanced aspects of hemodynamic profiling. The parameters that must be included in a complete hemodynamic profile are discussed with emphasis on the importance of index values. An algorithm is included as a guideline for use of the hemodynamic profile. A variety of clinical examples are discussed to illustrate the importance of hemodynamic profiling as an adjunct to expert critical care nursing practice.
Emergency Exploratory Sternotomy: The Nurse’s Role
Authors: Kern Leslie S.
Published: January 2016

Emergency exploratory sternotomy (EES) is a life-saving procedure performed in the recovery room or ICU within the first 24 hours following cardiac surgery. Complications that may necessitate this procedure include: tamponade, hemorrhage, acute profound hypotension, atypical tamponade, coronary artery spasm, clotted grafts, refractory dysrhythmias, and cardiac arrest. The nurse plays an important role in the early recognition of these life-threatening situations and therefore must be able to recognize clinical signs that may preclude the need for EES. This article details the four clinical scenarios the nurse will see, which are: (1) cardiac tamponade, (2) acute profound hypotension where the etiology is unclear, (3) cardiac arrest unresponsive to standard CPR and drug therapy, and (4) acute massive hemorrhage where tamponade is not the primary presenting condition. The procedure for EES is discussed, including preprocedure preparations, the nurse’s role in EES, and the post-EES nursing assessment. Nursing diagnoses appropriate to this event are outlined. There is a discussion on how to educate staff on EES as well as a discussion of the research outcomes of EES. Nurses caring for adult and pediatric cardiac surgery patients will find this information useful in establishing protocols for EES as well as in educating staff on how to respond effectively during this life-threatening event.
The Dying Patient in the Critical Care Setting: Making the Critical Difference
Authors: Caswell Deborah , Omery Anna
Published: January 2016

Death is an inevitable fact in the critical care setting. This fact does not make it more comfortable for the nurse who is caring for a critically ill patient who is dying. Some health care providers have recommended that the critical care resources are better utilized for the patient whose prognosis is not death. This position can be countered with the perspective that there may be no better place to provide the intensive nursing care that the dying patient may need than the critical care setting. A new nursing diagnosis, Terminal Syndrome related to the dying process is introduced to assist the nurse in providing comprehensive care for what is often a complex patient care situation. The goal is to achieve for each dying individual in the critical care setting what she or he truly desires, an end to the life process, a death achieved with comfort and dignity.
Noninvasive Assessment of Gas Exchange in the Critically Ill Patient
Authors: Von Rueden Kathryn T.
Published: January 2016

A variety of technologies is available to noninvasively evaluate arterial oxygen saturation and partial pressure of serum oxygen (PaO2) and carbon dioxide (PaCO2) in the critically ill patient. These include pulse oximeters, transcutaneous monitoring devices, capnometry, and capnography. Understanding the technology, the clinical significance of the data, and the associated limitations is fundamental in optimizing patient assessment and management. Accordingly, critical care nurses have increasing responsibilities related to these aspects of patient care
New Techniques for Weaning Difficult Patients from Mechanical Ventilation
Authors: Witta Kathy
Published: January 2016

This article compares the weaning of challenging patients from mechanical ventilation to an exercise training program experienced by many athletes. Physically, the importance of the correction and maintenance of chronic health issues, nutrition, and hydration are explored. Psychologically, the degree of preparedness by both the patient and the health care team is presented. Parameters for predicting readiness to wean that include both objective and subjective indices are gaining more support; two tools for weaning are offered. During the weaning process, reconditioning of the respiratory muscles can be promoted through endurance or strengthening exercises or a combination of both. The quality and quantity of exercise performed must be closely monitored to prevent respiratory muscle fatigue or atrophy. Newer modes of ventilation, including pressure support ventilation, mandatory minute ventilation, and continuous flow, decrease the work of breathing, promote ventilator/patient synchrony, and provide a more dynamic weaning process. All of these modes promote exercise, and augment the physical and psychological components of weaning. Nursing considerations for successful weaning are offered
Embryologic and Physiologic Basis of Neonatal Respiration
Authors: Turner Barbara S.
Published: January 2016

Development of the respiratory system requires the integration of anatomic, physiologic, and biochemical factors. This process is described from 5 weeks gestation until establishment of respirations after birth
Choosing A Wound Dressing: A Systematic Approach
Authors: Cuzzell Janice Z.
Published: January 2016

Wound care presents a particular challenge in the critical care setting. Decisions about how to cleanse a wound and which dressing to use are often complicated by unexpected changes in the patient’s condition, or the sudden occurrence of a wound infection. In this high-risk patient population, timely changes in topical therapy often can mean the difference between a wound that heals, or one that rapidily deteriorates. Much of the confusion over wound care and wound care products can be minimized by using a systematic approach to wound assessment. This chapter describes such an approach and summarizes local treatment options based on wound appearance
The Influence of Tissue Oxygen and Perfusion on Wound Healing
Authors: Whitney Joanne D.
Published: January 2016

The availability of oxygen (O2) to cells in the wound area and the presence of adequate blood flow are important factors to the healing process. Oxygen plays a critical role in the formation of collagen, the growth of new capillaries, and the control of infection. Perfusion and delivery of O2 to tissue are closely related. Although an adequate blood flow does not guarantee a sufficient supply of O2, without it the provision of O2 to healing tissues will be impaired. Basic scientific studies have clarified how O2 and blood flow influence healing. Recent research has focused on clinical populations and begins to provide direction for additional clinical studies and interventions to support the healing process. Based on existing research, clinical interventions aimed to maintain perfusion and supply of O2 include fluid volume assessments, pulmonary hygiene regimens, postoperative position changes, and ambulation
Development of Outcome Standards in Critical Care
Authors: Kuhn Rebecca C.
Published: January 2016

The forces influencing the development of outcome standards are gaining momentum. These forces are professional nursing issues, accreditation standards, and reimbursement issues. Traditionally, structure and process measures provided the means for evaluating the quality of nursing care. But nurses also play an important role in achieving positive patient outcomes. Outcome standards provide a mechanism for measuring patient outcomes. In 1990, the American Association of Critical-Care Nurses (AACN) published Outcome Standards for Nursing Care of the Critically Ill. The book serves as a model for developing and using outcome standards in critical care units. This chapter describes these outcome standards and recommends ways to use them. The Joint Commission on the Accreditation of Healthcare Organizations’ (JCAHO) ten-step model outlines development of unit-specific outcome standards. Methods focus throughout on a quality assurance framework
A Unit-Based Approach to Outcome Centered Nursing Quality Assurance in Critical Care
Authors: Day Geri , Powell Marcia E.
Published: January 2016

This chapter describes a unit-based nursing quality assurance program in critical care. It outlines a unit-based structure, implementation of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ten steps and joint nurse/physician outcome indicators
Standards of Care and Practice: A Vital Link in Quality Assurance
Authors: Walker Jeanne , Claflin Nancy
Published: January 2016

In the critical care unit setting, a quality assurance program is based on the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) ten-step model for monitoring and evaluation. The addition of nursing standards of patient care and standards of nursing practice to that ten-step model provides the vital link between patient expectations, staff performance, and quality assurance in that unit
Pacemaker Technology: An Overview
Authors: Finkelmeier Nancy E.
Published: January 2016

Cardiac pacing has evolved considerably over the past 30 years. Early pacemakers were nonprogrammable asynchronous devices which prevented asystole, syncope, and death. The current generation of implantable devices is much more sophisticated. With multiprogrammable features, these devices are intended not only to save life but also to improve the quality of life. This chapter reviews the pacemaker mode-code, indications, electronic circuitry, power sources, and programmable/telemetry features of current devices
Dual-Chamber Pacing
Authors: McErlean Ellen Strauss
Published: January 2016

Dual-chamber pacing has been available since the early 1980s, yet it is a topic with which critical care nurses consistently have difficulty. New advances in pacemaker technology have built on the principles inherent in dual-chamber pacing, making it imperative that practitioners have a basic-understanding of dual-chamber pacemaker function. With dwindling clinical resources, the responsibility of the bedside nurse to evaluate appropriate pacemaker function and identify the patient’s response to pacemaker therapy has increased
The Family as a Source of Support for the Critically Ill Adult
Authors: Simpson Terri
Published: January 2016

A conceptual framework of supportive family functions derived from a previous analysis of taped visits to coronary care unit (CCU) patients was used to analyze CCU and surgical intensive care unit (SICU) patients’ recollections about visits. The framework of family functions was supported by the patients’ recollections. However, CCU patients recall behaviors in a different order of frequency than previously described with visit transcript analysis. Both CCU and SICU patients frequently recall caring actions of the family and evaluated visits overall as helpful. Principles are proposed for nurses in assisting families and patients to cope with the critical illness episode and thus provide a supportive visiting environment for patients
Promoting Family-centered Visitation Makes a Difference
Authors: Wincek Jenifer M.
Published: January 2016

Promoting parental and sibling visitation of the critically ill child can positively influence the resolution of a crisis when a child is admitted to the pediatric intensive care unit. There are many benefits as well as barriers to incorporating family-centered visitation into the plan of care. Understanding the needs, stressors, and coping styles of the entire family will help the nurse provide a positive experience when parents or siblings visit the critically ill child
Emergent Admission to the Pediatric Intensive Care Unit: Parental Concerns
Authors: Youngblut Joanne M. , Jay Susan Schaeffer
Published: January 2016

To identify parental concerns when a child is suddenly admitted to the pediatric intensive care unit, 17 parents often critically ill children were interviewed using a structured format between 20 and 36 hours after admission about their concerns around the time of admission and at the time of interview using the Parental Concerns Scale. The individual concern items receiving the highest ratings were the child’s survival, the possibility of mental or physical impairment, the child’s diagnosis, and the amount of pain experienced by the child. Total concern scores decreased over time for both mothers and fathers when the child’s prognosis was good and, for mothers only, when the child had an infectious illness rather than accidental injuries. Implications for nursing practice are discussed
Weaning from Mechanical Ventilation: A Method for Assessment and Planning
Authors: Burns Suzanne M. , Fahey Sharon A. , Barton David M. , Slack Deborah
Published: January 2016

Weaning patients from mechanical ventilator assistance is difficult and often requires the input of experts. Though researchers have identified numerous factors that impede weaning and continue to develop criteria to determine ability to wean, no single factor or set of criteria have yet emerged to guide clinicians. In an effort to design a tool that assists critical care nurses in forwarding the wean process, the authors developed a comprehensive, integrated, computerized ventilator weaning program that stimulates the thinking and care planning strategies of experts. The Burns Wean Assessment Program also teaches complex concepts and tracks the progress of the weaning patient
Respiratory Muscle Conditioning and the Work of Breathing: A Critical Balance in the Weaning Patient
Authors: Shekleton Maureen E.
Published: January 2016

Normal ventilatory function depends on a balance between ventilatory demand and ventilatory capacity. The respiratory muscles play a critical role in achieving this balance. For patients experiencing ventilatory dysfunction, interventions that improve respiratory muscle function and therefore increase ventilatory capacity may be one way of restoring the balance and promoting ventilatory function. Respiratory muscle conditioning, or training the muscles to improve their strength and endurance, may be a useful clinical intervention in the weaning patient. Results of research show that muscle training may increase the ability of some patients to resume spontaneous ventilation. Continued research is needed to identify the appropriate training protocols for patients experiencing an acute imbalance between ventilatory demand and capacity
Chest Physiotherapy in Neonates: A Review
Authors: Dulock Helen L.
Published: January 2016

Chest physiotherapy (CPT) is performed on neonates with actual or potential pulmonary problems. The focus of this review is on research related to the effectiveness of or the physiologic alterations related to CPT. Findings from this review indicate that CPT in neonates: 1) did not significantly improve oxygenation or secretion removal in the first 24 hours of life in premature infants with respiratory distress syndrome, 2) increased oxygen consumption, and 3) prevented post-extubation atelectasis. Nursing considerations when performing this procedure, contra-indications, and documented side effects are included in this review
Dyspnea in the Weaning Patient: Assessment and Intervention
Authors: Carrieri-Kohlman Virginia
Published: January 2016

Dyspnea, the subjective sensation of uncomfortable breathing, is frequently experienced by patients during weaning from mechanical ventilation. As the clinical manifestation of increased work of breathing, dyspnea can be a valuable predictor and indicator of changes in patient respiratory status during the weaning process. The importance of measuring dyspnea is emphasized and the numerical rating and visual analog scales as direct measures of dyspnea are described. The most reliable physiologic variables that can be used to indirectly estimate dyspnea are discussed. Strategies such as positioning, coaching, “bagging,” inspiratory muscle training, pressure support ventilation, oxygen, and relaxation/biofeedback techniques that can be used by the critical care nurse to decrease dyspnea are suggested
Centrifugal Ventricular Assist Devices
Authors: Quaal Susan J.
Published: January 2016

A centrifugal ventricular assist device (VAD) uses centrifugal force to propel blood through nonocclusive pumpheads. Blood is diverted from either the right atrium or left atrium to a disposable pumphead. Then kinetic energy is added to blood contained within the VAD by rotating it at high speed. Centrifugal force generates energy which causes the blood to rise from the pump-head’s base, thus forcing a return flow direction. Centrifugal VAD design has been used to sustain myocardial function when patients could not be weaned from cardiopulmonary bypass and as a bridge to transplantation. Interaction between centrifugal VAD and human hosts are complicated and multisystemic. Therefore a multidisciplinary VAD support team is most efficacious. A case study, nursing diagnoses, and care plan provide a comprehensive overview of nursing management for this patient population
The Hemopump Temporary Cardiac Assist System
Authors: Rountree W. Donald
Published: January 2016

The Hemopump temporary cardiac assist system is currently in clinical trials at several centers across the United States and abroad. Patients with postcardiotomy low cardiac output or patients with cardiogenic shock secondary to acute myocardial infarction may greatly benefit from this device. Theory of pump operation, patient selection, and nursing management is discussed. Presentation of a case study demonstrating the effect of Hemopump support will be provided. A detailed nursing care plan as well as application of research findings to clinical practice will be outlined. As cardiovascular technology progresses, the critical care nurse must continue to be involved in all aspects of patient care. The Hemopump may prove to be a highly beneficial mode of ventricular assistance for patients with inadequate cardiac function
The Total Artificial Heart
Authors: Barker Lawrence E.
Published: January 2016

In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device
Cardiac Surgery in the Elderly: The Critical Care Phase
Authors: Brown Carolyn S.
Published: January 2016

A growing number of elderly patients (aged 70 years and older) are seen in critical care units after valve surgery or coronary artery bypass grafting. While studies show that the elderly demonstrate overall successful results after cardiac surgery, the mortality and morbidity risks are higher than in younger adults. The elderly patient is more likely to experience postoperative complications, prolonging the recovery phase. Commonly reported postoperative complications include dysrhythmias, pneumonia, cerebral vascular accidents, and infection. Elderly surgical candidates must be evaluated preoperatively to determine risk factors that may affect the critical care recovery phase. The length of stay tends to be longer in the intensive care unit, requiring nursing care that takes the aging process into consideration. The following article focuses on trends in cardiac surgery in the elderly, physiologic factors that affect outcome and recovery, and nursing interventions aimed at preventing or limiting postoperative complications
The Elderly and Thyrotoxicosis
Authors: McMorrow Mary Ellen
Published: January 2016

Thyrotoxicosis is gaining recognition as a significant clinical problem in the elderly. However, distinguishing thyrotoxicosis is difficult because the elderly usually present with nonspecific and atypical clinical manifestations. The most common cause of hyperthyroidism in the elderly is toxic multinodular goiter. The second most common cause is diffuse toxic goiter (Graves’ disease). With the elderly thyrotoxic patient, cardiovascular clinical manifestations usually predominate. The elderly frequently have palpitations, tachycardia, atrial fibrillation, and congestive heart failure. Atrial fibrillation and congestive heart failure are resistant to conventional cardiac glycoside therapy. The elderly may be treated with thioureas, beta-blockers, and when they are euthyroid, radioactive iodine. At risk for thyroid storm, the elderly thyrotoxic patient must be monitored carefully for predisposing factors; especially respiratory infections. Treatment for thyroid storm includes recognition and elimination of the precipitating factor(s); control of fever, if present; thioureas (antithyroid medications); beta-blockers, and sodium iodine
Arrhythmogenic Mechanisms
Authors: Abraham Terri
Published: January 2016

The arrhythmogenic mechanisms are the basis for the genesis of a wide variety of complex dysrhythmias that can arise in both pacemaker and nonpacemaker cells. Automaticity, or the ability to rhythmically and spontaneously depolarize cardiac cells, is normally the domain of the sinus node. Altered automaticity takes place when conduction is enhanced or abnormal. A second mechanism, reentry, refers to a phenomenon that occurs when an impulse is delayed within a pathway of slow conduction and then reenters surrounding tissue and produces another impulse. One-way conduction is necessary to produce a return route for the reentrant circuit. Lastly, late potentials are fragmented, low-amplitude electrical currents that occur at the terminal portion of the QRS complex or during the ST segment. Supraventricular and ventricular beats and tachydysrhythmias are the consequences of these mechanisms. Common contributing factors include but are not limited to hypoxia, hypercapnia, electrolyte disturbance, catecholamines, and pharmacotherapy