Establishing a Contingency Plan to Improve Patient Comfort During Peripherally Inserted Central Catheter Insertions: A Quality Improvement Effort

2021 ◽  
Author(s):  
Scott T. Wagoner ◽  
Jamie Lorenc ◽  
Elizabeth Edmunson ◽  
Jennifer V. Schurman
Keyword(s):  
Process Development ◽  
Scale Up ◽  
Lessons Learned ◽  
Patient Comfort ◽  
Quality Improvement Effort ◽  
Patients At Risk ◽  
Future Work ◽  
Improve Patient ◽  
State Scale

Highlights Abstract Background: Negative outcomes can occur when painful experiences related to needle procedures are not addressed. Patients at the institution in this study were not demonstrating sufficient levels of comfort during peripherally inserted central catheters (PICC) placements, so formal assessment of discomfort or distress began via the Pediatric Sedation State Scale (PSSS), and an enhanced approach to comfort planning, built around the Comfort Promise, was implemented. Over 1 year, we aimed to increase the percent of patients meeting sufficient comfort during PICC insertions by our Vascular Access Team (VAT) from 54% to 65%. Methods: Initially, VAT staff were educated on use of the PSSS and began routinely charting the highest score obtained during each PICC placement. Interventions were delivered concurrently and included (1) changing the VAT culture, (2) process development, (3) consensus building and scale up, and (4) information system modifications. Results: During the project period, 421 PICC insertions were completed. From baseline to the last 8 months, the percent of patients rated as experiencing sufficient comfort (PSSS = 2–3) during PICC placement increased from 54% to 74%, with the percent of patients experiencing significant discomfort or distress (PSSS = 4–5) decreasing from 45% to under 7%. Conclusions: Success in this project required a culture change. Building consensus by engaging others and integrating with the processes, preferences, and priorities of each area was key. Future work will focus on increasing use of all Comfort Promise bundle elements, identifying patients at risk for escalation, and taking a long-term view to comfort planning, as well as applying lessons learned to other needle procedures.

Viable Production of Diesel From Non-Recyclable Waste Plastics

2013 ◽  
Author(s):  
John William Bordynuik
Keyword(s):  
Process Development ◽  
Scale Up ◽  
General Purpose ◽  
Lessons Learned ◽  
Waste Plastics ◽  
Liquid Hydrocarbons ◽  
Waste Plastic ◽  
Wide Range ◽  
Grand Island ◽  
Barriers And Challenges

The art of refining liquid hydrocarbons (crude oil) into diesel, gasoline, and fuel oils was commercially scaled decades ago. Unfortunately, refineries are technologically limited to accepting only a very narrow range of liquid hydrocarbons with very specific properties and minimal contaminates. Unrecyclable, hydrocarbon-based waste is a significant environmental problem increasing every year. According to the Environmental Protection Agency’s 2010 Facts and Figures report, over 92% of waste plastic is not recycled and with a growth rate of approximately 8% per year, there exists a critical need for a viable and environmentally sound, general purpose hydrocarbon-based recycling process. Hydrocarbon streams that fall outside of accepted refinery standards have traditionally been landfilled or melted into products of low value. The barriers and challenges are so great that previous attempts to refine waste plastics into fuel resulted in unviable batch-based machines producing low-value, unstable mixed fuels. However, over the course of three years JBI, Inc. (“JBI”) has broken through these barriers and has designed and built a viable commercial-scale continuous refinery capable of processing a wide-range of hydrocarbon-based waste into ASTM specification fuels. Research and testing of scale-up through 1-gallon, 3000 gallon, multi-kiln, and 40 ton/day processors took place in a plant in Niagara Falls, NY. Technical challenges encountered and lessons learned during process development will be explained in detail. In 2009, our technology was “molecularly audited” by IsleChem, LLC (“IsleChem”) of Grand Island, NY and in 2012, the full-scale plant was viably validated by SAIC Energy, Environment & Infrastructure, LLC (“SAIC”). Numerous sources of waste plastic and users of the resulting fuel products conducted extensive audits of the technology, process, and plant. For the purpose of this paper, processing of waste plastics will be discussed in detail; however, this technology can be applied to other waste hydrocarbon-based materials such as contaminated monomers, waste oils, lubricants and other composite waste streams.

scholarly journals Clean manufacturing powered by biology: how Amyris has deployed technology and aims to do it better

2020 ◽  
Vol 47 (11) ◽  
pp. 965-975 ◽  
Author(s):  
Paul Hill ◽  
Kirsten Benjamin ◽  
Binita Bhattacharjee ◽  
Fernando Garcia ◽  
Joshua Leng ◽  
...  
Keyword(s):  
Data Science ◽  
Process Development ◽  
Scale Up ◽  
Strain Engineering ◽  
Lessons Learned ◽  
Product Portfolio ◽  
Fermentation Products ◽  
The World ◽  
Clean Manufacturing ◽  
Transfer Procedures

AbstractAmyris is a fermentation product company that leverages synthetic biology and has been bringing novel fermentation products to the market since 2009. Driven by breakthroughs in genome editing, strain construction and testing, analytics, automation, data science, and process development, Amyris has commercialized nine separate fermentation products over the last decade. This has been accomplished by partnering with the teams at 17 different manufacturing sites around the world. This paper begins with the technology that drives Amyris, describes some key lessons learned from early scale-up experiences, and summarizes the technology transfer procedures and systems that have been built to enable moving more products to market faster. Finally, the breadth of the Amyris product portfolio continues to expand; thus the steps being taken to overcome current challenges (e.g. automated strain engineering can now outpace the rest of the product commercialization timeline) are described.

scholarly journals “It Makes You Feel That You Are There”: Exploring the Acceptability of Virtual Reality Nature Environments for People with Memory Loss

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 27
Author(s):  
Noreen Orr ◽  
Nicola L. Yeo ◽  
Sarah G. Dean ◽  
Mathew P. White ◽  
Ruth Garside
Keyword(s):  
Virtual Reality ◽  
Long Term Care ◽  
Memory Loss ◽  
Lessons Learned ◽  
Framework Analysis ◽  
Term Care ◽  
People With Dementia ◽  
Future Work ◽  
With Memory

Aim: To report on the acceptability of virtual reality (VR) nature environments for people with memory loss at memory cafes, and explore the experiences and perceptions of carers and staff. Methods: A qualitative study was conducted between January and March 2019. Ten adults with memory loss, eight carers and six volunteer staff were recruited from two memory cafes, located in Cornwall, UK. There were 19 VR sessions which were audio recorded and all participants were interviewed at the end of the sessions. Framework analysis was used to identify patterns and themes in the data. Results: During the VR experience, participants were engaged to varying degrees, with engagement facilitated by the researcher, and in some cases, with the help of a carer. Participants responded positively to the nature scenes, finding them soothing and evoking memories. The VR experience was positive; many felt immersed in nature and saw it as an opportunity to ‘go somewhere’. However, it was not always positive and for a few, it could be ‘strange’. Participants reflected on their experience of the VR equipment, and volunteer staff and carers also shared their perceptions of VR for people with dementia in long-term care settings. Conclusions: The VR nature experience was an opportunity for people with memory loss to be immersed in nature and offered the potential to enhance their quality of life. Future work should build on lessons learned and continue to work with people with dementia in developing and implementing VR technology in long-term care settings.

Marinated in violence: therapeutic intervention for victims of domestic abuse

2014 ◽  
Vol 17 (4) ◽  
pp. 215-223
Author(s):  
Erin Pizzey
Keyword(s):  
Domestic Violence ◽  
Design Methodology ◽  
Lessons Learned ◽  
Relationship Building ◽  
Personal Account ◽  
Content Type ◽  
Social Environmental ◽  
Future Work ◽  
Narrative Account

Purpose – The purpose of this paper is to recount the author's experience of developing the first ever refuges for domestic violence, and the lessons learned about working with “violence-prone” people. Design/methodology/approach – This is a first hand, narrative account, interspersed with observations and commentary on the lessons learned. Findings – The author first identifies the author's own experience, as the child of several generations of violent parents, as central to the author's ability to empathise and work with women with similar histories. Learning together, and refusing to take responsibility away from the mothers, becomes central to the approach. Recognising the roots of violence requires in-depth, long-term relationship building with peers. The concept of “therapeutic chaos” sums up the way the spontaneous turmoil of the households seems to match and manage the cathartic expression of the residents’ world. Research limitations/implications – As a first hand account, this reportage challenges the assumption that constructive practice must all be based on someone else's prior, “evidence based”, practice. Originality/value – The refuge and network that arose from the work at Chiswick Women's aid was a pioneer in addressing domestic violence. This is a unique voice, and an opportunity to place this personal account in the record for future work on inter-generational emotional damage, addictive violence and social-environmental therapeutic treatments.

Maximizing Outcomes in Group Treatment of Aphasia: Lessons Learned From a Community-Based Center

2014 ◽  
Vol 24 (3) ◽  
pp. 100-105 ◽  
Author(s):  
Darlene Williamson
Keyword(s):  
Group Treatment ◽  
Treatment Protocol ◽  
Lessons Learned ◽  
Group Program ◽  
Community Based ◽  
Multiple Treatment ◽  
Use Of Technology ◽  
Communication Impairments ◽  
Treatment Settings

Given the potential of long term intervention to positively influence speech/language and psychosocial domains, a treatment protocol was developed at the Stroke Comeback Center which addresses communication impairments arising from chronic aphasia. This article presents the details of this program including the group purposes and principles, the use of technology in groups, and the applicability of a group program across multiple treatment settings.

Periodic monitoring of vampire bats and rabies: a new framework for animal restoration projects in the Neotropics

2020 ◽  
Author(s):  
Fernando Gonçalves ◽  
Daniel G. Streicker ◽  
Mauro Galetti
Keyword(s):  
Disease Transmission ◽  
Lessons Learned ◽  
Multidisciplinary Teams ◽  
Risk Area ◽  
Food Web Structure ◽  
Land Bridge ◽  
High Risk Area ◽  
Restoration Project ◽  
Vampire Bats

Nowadays, restoration project might lead to increased public engagement and enthusiasm for biodiversity and is receiving increased media attention in major newspapers, TED talks and the scientific literature. However, empirical research on restoration project is rare, fragmented, and geographically biased and long-term studies that monitor indirect and unexpected effects are needed to support future management decisions especially in the Neotropical area. Changes in animal population dynamics and community composition following species (re)introduction may have unanticipated consequences for a variety of downstream ecosystem processes, including food web structure, predator-prey systems and infectious disease transmission. Recently, an unprecedented study in Brazil showed changes in vampire bat feeding following a rewilding project and further transformed the land-bridge island into a high-risk area for rabies transmission. Due the lessons learned from ongoing project, we present a novel approach on how to anticipate, monitor, and mitigate the vampire bats and rabies in rewilding projects. We pinpoint a series of precautions and the need for long-term monitoring of vampire bats and rabies responses to rewilding projects and highlighted the importance of multidisciplinary teams of scientist and managers focusing on prevention educational program of rabies risk transmitted by bats. In addition, monitoring the relative abundance of vampire bats, considering reproductive control by sterilization and oral vaccines that autonomously transfer among bats would reduce the probability, size and duration of rabies outbreaks. The rewilding assessment framework presented here responds to calls to better integrate the science and practice of rewilding and also could be used for long-term studying of bat-transmitted pathogen in the Neotropical area as the region is considered a geographic hotspots of “missing bat zoonoses”.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

The effects of long-term vigorous endurance exercise on the coronary arteries

2019 ◽  
Vol 67 (2) ◽  
Keyword(s):  
Endurance Training ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
The Other ◽  
Disease Phenotype ◽  
Male Athletes ◽  
Artery Disease ◽  
Future Work ◽  
Summary Data

Moderate endurance training is known to improve cardiovascular risk factors, and prolongs life expectancy. On the other hand, there has been some discussion whether “too much” exercise might have a contrarious effect by accelerating coronary atherosclerosis. The goal of this review was to evaluate the current literature on the effects of long-term vigorous endurance training on the coronary vasculature. In summary, data point to an increased calcium score, and a higher burden of atherosclerotic plaque in male athletes compared to sedentary controls. However, the plaques found in athletes were more prone to be calcified. The pathogenesis and clinical relevance of this athlete coronary artery disease phenotype remains incompletely understood and represents an area of important future work.

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