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Volume Cxliv, Number 1, September 27, 2024, Lawrence University

The Lawrentian

No abstract provided.

Inexcusable Error: Finding A Balance Betweensound Will And The Stability Oftransactions, Moustafa Abou Mandour Moussa Aissa

Sultan Qaboos University Legal Studies Journal

Every contractor has a responsibility to be vigilant when finalizing a contract. This responsibility is founded on the belief that each contractor is best placed to evaluate their own goals and interests, and is therefore best equipped to protect and advocate for them. The contract is a receptacle of conflicting interests and differing objectives for its parties, so each party should hold themselves accountable before blaming the other. In legal practice and doctrine, it has been established that a contracting party's error will not render the contract invalid or terminated if it is an inexcusable error resulting from negligence or …

Leaving No Patient Behind! Expert Recommendation In The Use Of Innovative Technologies For Diagnosing Rare Diseases., Clara D M Van Karnebeek, Anne O'Donnell-Luria, Gareth Baynam, Anaïs Baudot, Tudor Groza, Judith J M Jans, Timo Lassmann, Mary Catherine V Letinturier, Stephen B Montgomery, Peter N Robinson, Stefaan Sansen, Ruty Mehrian-Shai, Charles Steward, Kenjiro Kosaki, Patricia Durao, Bekim Sadikovic

Faculty Research 2024

Genetic diagnosis plays a crucial role in rare diseases, particularly with the increasing availability of emerging and accessible treatments. The International Rare Diseases Research Consortium (IRDiRC) has set its primary goal as: "Ensuring that all patients who present with a suspected rare disease receive a diagnosis within one year if their disorder is documented in the medical literature". Despite significant advances in genomic sequencing technologies, more than half of the patients with suspected Mendelian disorders remain undiagnosed. In response, IRDiRC proposes the establishment of "a globally coordinated diagnostic and research pipeline". To help facilitate this, IRDiRC formed the Task Force …

A New Invasive Lepidosaphes Armored Scale (Hemiptera: Coccomorpha: Diaspididae) For Florida: First Records, Natural Enemies, And An Identification Key, Erin C. Powell, Mark Zenoble, Douglass R. Miller, Benjamin B. Normark, Gregory A. Evans

Insecta Mundi

The invasive armored scale, Lepidosaphes laterochitinosa Green 1925 (Hemiptera: Coccomorpha: Diaspididae), was found in the Florida landscape for the first time in November 2022 and is now known from two south Florida counties: Broward and Miami-Dade. In Florida thus far, this polyphagous species has been found on Epipremnum pinnatum (L.) Engl. (Araceae), Dracaena Vand. ex. L. (Asparagaceae), and Breynia disticha J. R. Forst. and G. Forst. (Phyllanthaceae), all common landscape ornamentals. New parasitoid host records are provided for Encarsia lounsburyi (Berlese and Paoli), Encarsia citrina (Craw), and Aphytis lingnanensis Compere (Hymenoptera: Aphelinidae) that emerged from L. laterochitinosa in Broward …

Little Lungs, Big Care: Prevent Unplanned Extubation, Leslie Huntington, Emily Jordan Ressman, Carmen Yearego

2024

QUALITY

Background: The pediatric critical care unit in a large medical center benchmarks a variety of quality metrics to ensure we are providing our patients with the best care. At the end of 2023, the unit rate of 0.58 was higher than the national benchmark rate of 0.33 for unplanned extubation (UE). Additionally, the unit was lower for failed extubation rate than the national benchmark which led to questioning if the unit was too conservative with when patients are deemed ready to extubate.

Objectives: The primary goal is to lower the rate of UE while maintaining a failed extubation rate …

Exploring Parent/Child Peri-Anesthesia Anxiety And Anesthesia Effects On Children, Ann Johnson, Alejandra Lozano, Pauline Chen

2024

RESEARCH

Approximately four million children undergo procedures with anesthesia yearly. For children and parents, this can be anxiety-provoking. In extant literature, level and timing of pre-anesthesia anxiety in children are not adequately studied; associated factors are largely unknown in humans. Preparing for anesthesia and its effects may cause parental worry, and little is known about these effects on school-age children in the weeks following a procedure. The purpose of this study was to explore longitudinal peri-anesthesia factors of anxiety and behavior in children ages 7 through 12. Spanish and English-speaking dyads consented to four data collection points beginning at the …

Nurse Manager Hiring Practices And The Experience Of New Graduate Nurses, Tiffany Montgomery, Zara Sajwani-Merchant

2024

RESEARCH

Purpose
/="/">Hiring decisions have implications for the hiring unit and the healthcare organization, including nursing retention, orientation costs, and organizational culture. Despite available literature, hiring practices, and diversity, equity, and inclusion practices are unknown within nurse residency programs. This study explores the experiences of nursing hiring managers and newly hired nurse candidates with the interview and hiring process into residency programs within the DFW metroplex.
/="/">Methods
/="/">A qualitative phenomenological study was conducted to describe the nursing manager experiences and thoughts through the hiring process and how they compare to nurse candidate’s perspective hired into an established …

Reducing The Burden Of Tracking Age Of Majority (Aom) Research Participant Consents, Beena Pappen, Lindsay Therrian, Bobby Lawrence

2024

QUALITY

Background
/="/">Reconsenting research participants when they reach Age of Majority (AOM) – age 18 in the state of Texas – is a vital responsibility of the pediatric research world. It requires tracking and planning for an activity that may not happen until months, years, or over a decade later. Not obtaining AOM consent may violate the rights of the research participant, as well as impede the ongoing collection and usage of their research data. At the Center for Cancer and Blood Disorders (CCBD) Clinical Research Office (CRO), a very manual process was being used to identify and notify …

Preventing Patient Deterioration By Creating A Reassessment And Escalation Process For The Ed Waiting Room, Virginia Elizondo, Amanda Caipo, Cory Carlos

2024

EBP

Practice Problem:

Long wait times in the emergency department (ED) waiting room significantly impact patient outcomes. Waiting times increase the risk of deterioration, the number of patients leaving without being seen (LWBS), and lead to dissatisfaction with care. 1,2,3 The urgency and significance of early recognition of abnormal vital signs and the appropriate responses cannot be overstated.3 Current ED practices lack a structured process for regular reassessment and escalation in the waiting room.

Literature/Evidence:

A comprehensive literature search was conducted, utilizing EBSCOhost, PubMed, and Ovid. The literature supports continuous reassessment to enhance safety and satisfaction in the waiting room. …

A Transformative Leadership Approach To Reducing Nursing Turnover In A Pediatric Cardiac Intensive Care Unit, Deniro Brown, Lindsey Daigle, Brandi Brown, Julia Gerstmann, Emily Hernandez, Delaney O’Brien, Casey Conrad, Christina Whittington, Lindsey Wren, Gustavo Barbero

2024

INNOVATION

Introduction/Objective:
Retention of nurses in the pediatric cardiac intensive care unit (CICU) is essential for optimal patient outcomes, as nurse experience significantly impacts patient mortality and hospital-acquired conditions. In April 2022, our CICU faced high voluntary turnover among direct bedside nurses. Our immediate goal was to reduce this turnover, with a longer-term objective of improving overall nurse retention.

Methods:|
We established global and SMART aims by comparing organizational benchmarks for nurse turnover with unit-specific data from human resources. Co-managers and eight nurse team leaders conducted stay interviews with direct bedside nurses during the first half of 2022. These …

Improving Sepsis Response, Awareness, And Engagement In The Emergency Department, Virginia Elizondo, Nicole Bizzack, Amber Dayton, Angie Rodick, Ashley Collins, Georgina Hernandez, Amber Albiar

2024

QUALITY

Sepsis background:
Sepsis is the leading cause of death in children² and a global health problem³. The primary source of infection is often not apparent¹, making early patient identification, initiation of sepsis protocols, and continued awareness crucial to improve outcomes and prevent mortality in patients at risk for sepsis.

Purpose:
An emergency department (ED) Sepsis Response Team (SRT) and other initiatives were designed to enhance workflow efficiency, improve time to antibiotic administration (TTA) tominutes, improve sepsis recognition, and uphold standards by maintaining staff engagement.

Implementations:
Once a patient screens positive for sepsis risk, an …

Bridging The Gap: Leveraging Cnap To Enhance Professional Development, Align With Organization Goals And Create A Culture Of Safety, Marissa Crosley, Brooke Harris, Gwenetta Hicks, Cornelius Metili

2024

INNOVATION

Abstract: As our organization strives for its fifth Magnet designation, enhancing nurse professional development has become a clear priority. Currently, only half of our nursing staff participate in the Clinical Nurse Achievement Program (CNAP), highlighting a need for increased engagement. Additionally, feedback from the latest Experience, Inclusion, and Engagement (EIE) Survey identified an opportunity to improve nurse recognition within our department. These insights prompted an exploration of how the Team Lead role, uniquely positioned between frontline nurses and leadership, could be more effectively utilized.

A key challenge identified is the time-consuming process of documenting CNAP achievements. Nurses often defer …

Closing The Gap For Psychiatric Resource Nurse Orientation, Kelly Bonilla, Madison Mcqueen, Cornelius Metili, Annietra Udoh

2024

EBP

A nursing orientation program can positively impact new nurses that are joining the organization (Nobles, 2022). The implementation of a new psychiatric nurse role within the hospital system developed the necessity for an orientation program that would provide quality, safe, and positive outcomes. Psychiatric Resource Nurse roles were created within the organization to provide support and education to staff regarding patients with behavioral or mental health needs. An orientation program was created to support the specific role of the Psychiatric Resource Nurse role to fulfill the need for patient centered care.

A need for an orientation program for Psychiatric …

Fall Prevention Strategies In A Pediatric Epilepsy Monitoring Unit, Bailey Cochrum

2024

EBP

Practice Problem: In 2023, our Epilepsy Monitoring Unit (EMU) had 8 falls, 5 with injuries, up from zero falls with injury in 2022. Enhancing patient and family education on fall risks and prevention is crucial for improving safety and reducing falls.

Literature: Falls in an EMU are common adverse events. Patients with epilepsy are at increased risk of falls due to seizures. In the EMU, seizures are provoked by changing medications, sleep patterns, and stimulation, increasing fall risk and possible injury.

Practice Change(s): For planned EMU admissions, we developed additional seizure-specific education for patients and families, sent prior …

Improving The Lactation Journey: Empowering Moms’ Utilization Of Breast Milk From Admission To Discharge In A Level Iv Neonatal Intensive Care Unit, Rebecca Palmer, Jerithea Tidwell, Traci Hankins, Sharetha Hollier, Nicole Jenkins, Dawn Schindler, Jeanne Gaines

2024

INNOVATION

Background
The benefits of MBM is well-known in literature, especially for infants admitted to the NICU. There is difficulty in engaging and empowering NICU mothers due to multiple barriers including holding limitations, inability to feed orally, and separation of mother and infant for extended periods. Opportunities for improving MBM utilization throughout admission include oral immune therapy (OIT) and/or oral care with MBM, skin to skin (STS), and non-nutritive attempts at breast. Access to lactation education, support, and resources throughout admission is imperative.

Methodology
Utilization of the plan-do-study-act (PDSA) cycle of quality improvement (QI) has improved our overall lactation processes …

Emergent Medication Labels In The Pediatric Intensive Care Unit, Christine Hajovsky

2024

EBP

PICOT: In emergent situations in a pediatric ICU requiring nurses to draw up emergent doses of medication, is it safer to use color coded, pre-printed fill-in-the-dose medication labels vs. our current practice of white handwritten labels? In our pediatric ICUs, nurses use handwritten labels for emergent drug administration, which can lead to illegibility and increased risks of adverse events. This project assessed whether pre-printed, color-coded, fill-in-the-blank labels enhance nurse confidence and nurses’ perceptions of patient safety during emergent drug procedures.

Literature/Evidence: Search strategy in the CINAHL (EBSCOhost) database used MeSH headings and keywords, including English articles published within the …

Ironing Out The Details: Early Detection And Treatment Of Iron Deficiency In A Level 4 Nicu, Rachel Mills

2024

EBP

Practice Problem: In a level 4 neonatal intensive care unit (NICU), no standardized method existed for identifying and treating iron deficiency (ID) in preterm or low birth weight (LBW) infants. Common practice was to adjust iron supplementation based on hematocrit levels, though this was not based on any formal protocol or guideline. ID of the brain in neonates may be associated with neurologic and developmental deficits. Thus, it is prudent to identify and treat early. In a recent survey, providers reported a lack of familiarity with biomarkers for early identification of ID.

Literature/Evidence: A comprehensive review of the literature …

Ready, Set, Code! Investigating The Use Of Two Standardized Resuscitation Algorithms To Improve Outcomes In Patients In A Level 4 Nicu, Lauren Ayala, Grace Farina, Shelby Hudson, Anna Nguyen, Mireya Ortiz, Luke Wuesthoff

2024

EBP

Background:
Resuscitation efforts can be challenging in a Level IV NICU. Most Heath Care Providers in pediatric hospitals are Pediatric Advanced Life Support (PALS) certified. Some NICU providers are certified in both Neonatal Resuscitation Program (NRP) & PALS. There is concern regarding use of NRP vs PALS for Level IV NICU patients who are up to one year of age. Strategies need to be identified to assist nurses in determining which resuscitation algorithm (PALS or NRP) to utilize during a code/peri-arrest event involving patients in a Level IV NICU.

PICO:
Will designing a resuscitation tool improve outcomes and effectiveness …

Partnering Up To Prevent Pediatric Peripheral Intravenous Infiltration, Melissa Ruffini, Ashlyn Coenraad, Rachael Burris-Alcala, Victoria Washington, Emily Jordan Ressman, Alexandra Birely

2024

QUALITY

Background: Peripheral Intravenous Infiltrations and Extravasations (PIVIE) occur in up to 78% of peripheral IVs (PIVs) in some pediatric studies. Proper site assessment is essential in preventing patient harm from PIVIEs, with hourly nursing assessments considered best practice for patients receiving continuous infusions. Many nurses work 12-hour shifts, and evidence suggests that inattentional blindness and cognitive bias can contribute to failure to notice physiologic differences in patient assessments over time. To address this challenge and ensure early identification of symptoms, the local project team proposed an innovative ‘buddy check’ approach to minimize patient harm.

Methods: This quality improvement project …

Standardization Of Adult Transition Across Ambulatory, Virginia Vecchio, Monica Fuller

2024

QUALITY

Background:

Historically, at Children’s Health initiatives involving patient transition to adult care have been focused on the clinics which are ranked in U.S. News & World Report’s Best Children’s Hospitals. Other clinics had no process for transition and were unaware of available resources.

Purpose:

A subgroup from the Ambulatory Clinical Practice Council identified the need for a standardized framework and EPIC documentation that every clinic could utilize.

Methodology:

The Office of Patient Transition (OPT) was onboard with revamping the current program and allowing nurses to drive the changes. A knowledge assessment was performed with nurses in 2022. The results …

Collaboration Is Key: Engaging A Multidisciplinary And Multi-Departmental Team To Create Clinical Practice Guidelines (Cpg) Within A Level Iv Nicu, Rebecca Palmer, Sushmita Yallapragada, Jeanne Gaines, Jerithea Tidwell, Kymeyone Lanehart, Charmaine Shaw

2024

INNOVATION

Background
Within a Level IV collaboration between different disciplines and departments is needed to provide care delivery that is effective and efficient. Emergent situations arise that require care to be provided quickly, including patients with necrotizing enterocolitis (NEC) and/or require bedside surgery. Upon review, multiple inconsistencies and inefficiencies were identified in these processes.

Implementation
Utilizing Lean and Quality Improvement methodology, CPGs were created for both necrotizing enterocolitis and bedside surgery. The steps taken in creation of these CPG include:
 • Identification of key stakeholders of all departments, including neonatology, surgery, and anesthesia
 • Evaluation of the Sepsis CPG to …

Residency Resources To The Rescue!, Jill Hesler, Martha Shaw

2024

INNOVATION

Collaboration and communication between residency facilitators and residency coordinators is imperative to overall nurse residency program and individual resident success. Increased cohort sizes and the lasting impact of a global pandemic to academia continued to contribute to a noticeable trend in nurse residents’ failure to progress. Failure to progress is defined as an inability to move forward during unit level orientation. Signs of failure to progress may include inability to perform new tasks or tasks previously completed, lack of interest in new opportunities, and anxiety disproportionate to the situation. This upward trend was made evident by an increase in …

Caring For Manes: Creating Diverse Hair Care Guidelines For A Large Pediatric Hospital, Jeri Tidwell, Tiffany Montgomery, Phyllis Carter-Riles, Victoria Washington, Kym Lanehart, Jesse Leos

2024

QUALITY

Background
Hair care products should be available to all patients regardless of hair type and texture. Recent movements like the Crown Project sparked pediatric hospitals across the country to focus efforts on ensuring hair care equity for their patients. Children’s health joined the movement by sanctioning a multidisciplinary, multidepartment task force to address BIPOC hair concerns. A smaller group was tasked with aligning practices and policies to address the gaps in education and resources available to assist nurses in caring for ethnic hair.

Methodology
Review of literature was conducted. Limited published work was found. The workgroup benchmarked and consulted …

Detection And Perception Of Naturalness In Drum Sounds Processed With Dynamic Range Control, Jaxon Stricker, Wesley Bulla, Song Hui Chon, Doyuen Ko

SPARK Symposium Presentations

This study examines whether trained listeners could identify and judge the “naturalness” of drum samples processed with Dynamic Range Compression (DRC) when paired with unprocessed samples. A two-part experiment was conducted utilizing a paired comparison of a 10-second reference drum loop with no processing and a set of drum loops with varying degrees of DRC. In Part 1, subjects were instructed to identify which sample of the two they believed to have DRC applied. They were then asked to identify which sample they believed sounded “more natural” in Part 2. Out of 18 comparisons for Part 1, only three demonstrated …

Incorporation Of Undissolved Lime From Previous Applications Can Ameliorate Subsoil Acidity Promptly And Improve Crop Performance On Sandy Soils Of The Semi-Arid Regions Of Western Australia, Gaus Azam, Md. Shahinur Rahman

Grain and Other Field Crops Research Articles

Background and aims

Repeated surface application of lime for managing subsoil acidity is slow and ineffective, resulting in an accumulation of undissolved lime (carbonate) in the topsoil. We investigated the impact of the incorporation of undissolved lime into the subsoil to improve acidity and crop performance.

Methods

The undissolved lime in 2-cm layers of topsoil (0–10 cm) from three long-term experiments in Western Australia was measured. Both limed and unlimed topsoil with the acidic subsoil of the same profile was incubated at eight incorporation rates for six weeks, followed by growing barley and wheat in the incubated soil for two …

Case Study In Deaf Mental Health Care: Integration Of Therapeutic Attunement And Skills-Training, Julia Ball, Lindsey Sankin

JADARA

Deaf Mental Health Care (DMHC) is a specialty involving clinical expertise and self-awareness in therapeutic work with D/deaf people.1 Within the DMHC framework, this case report describes the psychotherapy of one Deaf individual, whose developmental experiences are common among D/deaf people. It illustrates how clinical models developed with hearing people informed the clinical team working with this Deaf individual. The treatment integrated focused skill-building with reparative emotional and linguistic “attunement.” In addition, the case illustrates how clinicians and their clients can use the intersections of their different languages and cultures as growth opportunities.

Nebraska Monthly Economic Indicators: September 27, 2024

Bureau of Business Research Publications

Nebraska Monthly Economic Indicators, September 27, 2024, from the Bureau of Business Research at the University of Nebraska-Lincoln.

A Methodical And Multidisciplinary Approach To Reducing Unplanned Extubationin A Level Iv Nicu, Rebecca Palmer, Ashley Reed, Reed Graham, Nimrod Otieno, Veronica Contreras, Jeanne Gaines, Jerithea Tidwell, Alice Figueroa, Travis Reynolds, Syed Ahmed, Sushmita Yallapragada

2024

QUALITY

Background: Unplanned extubations (UE) in neonates can result in severe consequences such as airway obstruction, hypoxia, respiratory distress, and even death. It is crucial to prevent UEs to maintain stable breathing, minimize the need for reintubation, and improve outcomes for neonates in the neonatal intensive care unit (NICU). The multidisciplinary NICU UE team has been working to prevent UEs since 2017. After an increase in 2022, the team conducted an evaluation to identify potential gaps and discovered over 50% of patients were not being reintubated post-event. Identified factors that contributed to UE events were: infants with weight < 4 kilograms; unadjusted high endotracheal tubes (ETT) per x-ray; inadequate sedation; lack of extubation readiness trial; and inadequate taping of the ETT. In 2022, our UE rate spiked to 0.50 UEs/100 vent days which prompted our multidisciplinary team to reinvigorate our work.

Methodology: A …

An Edge Platform Streamlining Connectivity Between Modern Edge Devices And Cloud, Anderson Carvalho

Theses

The numerous uses of cloud, fog, and edge computing in a variety of industries are thoroughly examined in this thesis, with a special emphasis on smart factories, smart cities, and smart agriculture. It starts with an introduction to cloud computing, going over its history, importance in contemporary digital infrastructures, and related security concerns. It emphasizes the value of cloud computing for processing and storing data while addressing issues like guaranteeing low latency applications and possible improvements from container technologies. The conversation then shifts to fog computing, going over its history, designs, and uses. It focuses on how fog computing might …

Corrigendum To “A Two-Stage Deformation Of The Anatolian Plate Deduced Frompaleomagnetic Signals: The Initial Age Of The Anatolian’S Escape” [Turkish Journal Ofearth Sciences 33 (3) 2024 243-259 ], Mualla Cengi̇z, Savaş Karabulut

Turkish Journal of Earth Sciences

This corrigendum is to address an issue regarding the manuscript's previous title. The authors have regrettably noticed that the title is incorrect in the original published version of this paper. To rectify this oversight and ensure the accuracy of the published work, the title has been corrected for your reference below: A two-stage deformation of the Anatolian plate deduced from paleomagnetic signals: the initial age of the Anatolian escape.

Link to the original submission: https://journals.tubitak.gov.tr/earth/vol33/iss3/2/