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Objectives: Older people with care needs are often supported by their older care-partners (50+). Over time, the increased demand in care needs can result in the care partner placing their own health needs aside. This study was aimed at establishing and piloting a novel co-designed Carer Health and Wellbeing Service (CHWS) that offers multidisciplinary (social work, psychology, occupational therapy, and physiotherapy) one-to-one support to care partners.
Methods: We conducted a pre-post 6-month study design including qualitative and quantitative Methods. Consenting individuals attending the CHWS completed five measures pre- and post- their interaction with the CHWS: Carer Support Needs Assessment Tool (CSNAT); Preparedness for Caregiving Scale (PCS); Family Appraisal of Caregiving Questionnaire (FACQ); EuroQoL Five Dimension Five Level Scale (EQ-5D-5L); and Health Economics Survey.
Results: Service operation commenced 1 day/week in March 2024 with 16 participants to date. Preliminary pre- service use indicates care partners feel underprepared for the carer role (particularly emotionally and psychologically), experience high levels of guilt when addressing their own care needs and are unsure about how to advocate or navigate the existing support system. Care partners have been coached to identify, prioritize, and address their current health and wellbeing needs. Additional findings regarding the implementation of the CHWS will be reported in this presentation.
Conclusions: The preliminary sample presents several emotional and psychological needs that need addressing. These will inform the type of support services to be provided as part of the CHWS, which will also be presented at the conference.
Agriculture has been dominated by annual plants, such as all cereals and oilseeds, since the very beginning of civilization over 10,000 years ago. Annual plants are planted and uprooted every year which results in severe disturbance of the soil and disrupts ecosystem services. Science has shown that it is possible to domesticate completely new perennial grain crops, i.e. planted once and harvested year after year. Such crops would solve many of the problems of agriculture, but their development and uptake would be at odds with the current agricultural technology industry.
Technical summary
Agriculture is arguably the most environmentally destructive innovation in human history. A root cause is the reliance on annual crops requiring uprooting and restarting every season. Most environmental predicaments of agriculture can be attributed to the use of annuals, as well as many social, political, and economic ones. Advances in domestication and breeding of novel perennial grain crops have demonstrated the possibility of a future agricultural shift from annual to perennial crops. Such a change could have many advantages over the current agricultural systems which are to over 80% based on annual crops mainly grown in monocultures. We analyze and review the prospects for such scientific advances to be adopted and scaled to a level where it is pertinent to talk about a perennial revolution. We follow the logic of E.O. Wright's approach of Envisioning Real Utopias by discussing the desirability, viability, and achievability of such a transition. Proceeding from Lakatos' theory of science and Lukes' three dimensions of power, we discuss the obstacles to such a transition. We apply a transition theory lens to formulate four reasons of optimism that a perennial revolution could be imminent within 3–5 decades and conclude with an invitation for research.
To assess the impact of a diagnostic test stewardship intervention focused on tracheal aspirate cultures.
Design:
Quality improvement intervention.
Setting:
Tertiary care pediatric intensive care unit (PICU).
Patients:
Mechanically ventilated children admitted between 9/2018 and 8/2022.
Methods:
We developed and implemented a consensus guideline for obtaining tracheal aspirate cultures through a series of Plan-Do-Study-Act cycles. Change in culture rates and broad-spectrum antibiotic days of therapy (DOT) per 100 ventilator days were analyzed using statistical process control charts. A secondary analysis comparing the preintervention baseline (9/2018–8/2020) to the postintervention period (9/2020–8/2021) was performed using Poisson regression.
Results:
The monthly tracheal aspirate culture rate prior to the COVID-19 pandemic (9/2018–3/2020) was 4.6 per 100 ventilator days. A centerline shift to 3.1 cultures per 100 ventilator days occurred in 4/2020, followed by a second shift to 2.0 cultures per 100 ventilator days in 12/2020 after guideline implementation. In our secondary analysis, the monthly tracheal aspirate culture rate decreased from 4.3 cultures preintervention (9/2018–8/2020) to 2.3 cultures per 100 ventilator days postintervention (9/2020–8/2021) (IRR 0.52, 95% CI 0.47–0.59, P < 0.01). Decreases in tracheal aspirate culture use were driven by decreases in inappropriate cultures. Treatment of ventilator-associated infections decreased from 1.0 to 0.7 antibiotic courses per 100 ventilator days (P = 0.03). There was no increase in mortality, length of stay, readmissions, or ventilator-associated pneumonia postintervention.
Conclusion:
A diagnostic test stewardship intervention was both safe and effective in reducing the rate of tracheal aspirate cultures and treatment of ventilator-associated infections in a tertiary PICU.
OBJECTIVES/GOALS: Optimize an Individual Retention Conversation (IRC) toolkit aimed at enhancing trust amongst CRPs and leadership via a 2-phase project wherein 9 academic medical centers (AMCs) with significant CRP workforces developed and assessed a 16 question IRC guide and accompanying manager/leader instructional guide. #_msoanchor_1 METHODS/STUDY POPULATION: Significant interest in adapting the Stay Interview concept for the CRP workforce led to a 2-phase pilot to optimize the re-envisioned IRC toolkit. Representatives from nine AMCs and research sites volunteered to navigate their respective institutional IRB processes to initiate the assessment. Additional sites, such as Frontiers Clinical and Translational Institute (Frontiers) launched variations of the IRCs outside of the structured QI project to meet the needs of their institutional environments and reported feedback to the larger group. Feedback on both the standardized IRC, as well as Frontiers’ tailored version, will be presented. This will serve as an entryway into Phase 2, a multi-institutional mixed methods evaluation project open to all AMC members of ACTS and the CRPT SIG. RESULTS/ANTICIPATED RESULTS: To date, 7 institutions have initiated IRCs with test groups at their institutions. Each institution had unique requirements, but all IRBs deemed Phase 1 to be exempt/not human research. Preliminary data suggest not only that the IRC process is valuable to both employee and their manager/unit leadership, but also that the simple act of conducting IRCs was found to be unique and meaningful to employees. For example, in their tailored IRC process, Frontiers found that the 90% of their team found the process to be beneficial (n=9). DISCUSSION/SIGNIFICANCE: By acknowledging issues, understanding motivations, and increasing engagement, IRCs foster positive change, allowing team leaders to take immediate action on important issues. By doing so, retention and engagement of team members, and the CRP workforce as a whole, is likely to grow and strengthen, as supported by results from our initial test pilots.
Acquire complete knowledge of the basics of air-breathing turbomachinery with this hands-on practical text. This updated new edition for students in mechanical and aerospace engineering discusses the role of entropy in assessing machine performance, provides a review of flow structures, and includes an applied review of boundary layer principles. New coverage describes approaches used to smooth initial design geometry into a continuous flow path, the development of design methods associated with the flow over blade shape (cascades loss theory) and annular type flows, as well as a discussion of the mechanisms for the setting of shaft speed. This essential text is also fully supported by over 200 figures, numerous examples, and homework problems, many of which have been revised for this edition.
A gas turbine engine is a device that is designed to convert the thermal energy of a fuel into some form of useful power, such as mechanical (or shaft) power or a high-speed thrust of a jet. The engine consists, basically, of a gas generator and a power conversion section, as shown in Figures 1.1 and 1.2.
In this chapter, we will get familiar with a unique performance gauge, which is not process dependent, but is rather state dependent, by definition. In other words, the newly defined, so-called “polytropic” efficiency is independent of the size of a turbomachine (in terms of the total-to-total pressure ratio). In addition, we will have a means of computing the overall efficiency of several stages, sharing the same total-to-total magnitudes of pressure ratio and efficiency, without having to resort to the thermodynamics of each individual stage. The point is made that adding more stages to a multistage turbomachine will have drastic, but totally opposite, effects on turbines as contrasted to compressors. We will prove through this exercise that adding more turbine stages enhances the performance of the final turbine configuration. The effect in compressors, on the other hand, is that of performance deterioration.
Consider the simplest nonafterburning, single-spool turbojet engine, which is schematically shown in Figure 12.1. Assuming a viable (i.e., stable compressor) operation mode, there are obvious constrains relating the gas-generator components to one another. These generally enforce the uniformity of shaft speed, as well as ensure the mass and energy conservation principles (Figure 12.2).
Utilization of axial-flow compressor stages (Figure 9.1) in gas turbine engines is a relatively recent development. The history of this compressor type began after an era when centrifugal compressors were dominant (Figure 9.2). It was later confirmed, on an experimental basis, that axial-flow compressors can run much more efficiently. Earlier attempts to build multistage axial-flow compressors entailed running multistage axial-flow turbines in the reverse direction. As presented in Chapter 4, a compressor-stage reaction, in this case, will be negative, a situation that has its own performance degradation effect. Today, carefully designed axial-flow compressor stages can very well have efficiencies in excess of 80%. A good part of this advancement is owing to the standardization of thoughtfully devised compressor-cascade blading rules.
In this chapter, the flow-governing equations (conservation laws) are reviewed, with applications that are purposely turbomachinery related. Particular emphasis is placed on the total (or stagnation) flow properties. A turbomachinery-adapted Mach number definition is also introduced as a compressibility measure of the flow field. A considerable part of the chapter is devoted to the total-relative properties, which, together with the relative velocity, define a legitimate thermophysical state. Different means of gauging the performance of a turbomachine, and the wisdom behind each of them, are discussed. Also explored is the entropy-production principle, as a way of assessing the performance of turbomachinery components. The point is stressed that the calculation of entropy production may indeed be desirable, for it is the only meaningful performance measure that is accumulative (or addable) by its mere definition.
From a historical viewpoint, the centrifugal compressor configuration was developed and used, even in the propulsion field, well before axial-flow compressors were. Due to their large envelope and weight (Figure 11.1), the common belief that such a “bulky” compressor type has no place except in aerospace applications is not exactly accurate. For example, with a typical total-to-total pressure ratio of, for example, 5:1, it would take up to three axial-compressor stages to absorb similar amounts of shaft work that a single centrifugal compressor stage would. In fact, the added engine length, with so many axial stages, would increase the skin friction drag on the engine exterior, almost as much as the profile drag, which is a function of the frontal area.
A brief introduction to gas turbine engines was presented in Chapter 1. Review of the different engines included in this chapter reveals that most of these engine components are composed of “lifting” bodies, termed airfoil “cascades,” some of which are rotating, while others are stationary. These are all, by necessity, bound by the hub surface and the engine casing (or housing), as shown in Figures 2.1–2.5. As a result, the problem becomes one of the internal-aerodynamics type, as opposed to such traditional external-aerodynamics topics as “wing theory” and others. Referring, in particular, to the turbofan engines in Chapter 1 (e.g., Figure 1.3), these components may come in the form of ducted fans. These, as well as compressors and turbines, can be categorically summed up under the term “turbomachines.” Being unbound, however, the propeller of a turboprop engine (Figure 1.2) does not belong to the turbomachinery category.
Historically, the first axial turbine utilizing a compressible fluid was a steam turbine. Gas turbines were later developed for engineering applications where compactness is as important as performance. However, the successful use of this turbine type had to wait for advances in the area of compressor performance. The viability of gas turbines was demonstrated upon developing special alloys that possess high strength capabilities at exceedingly high turbine inlet temperatures.
Figure 4.1 shows a general-type mixed-flow compressor rotor. The thermophysical states 1 and 2 represent average conditions over the entire inlet and exit stations, respectively. The rotor-blade-to-blade hub-to-casing passage is the control volume, and other than the continuity and energy equations (Chapter 3), we are now left with the momentum-conservation principle to implement.
Over more than three decades now, radial-inflow turbines have been established as a viable alternative to its axial-flow counterpart, specifically in power-system applications. Despite its relatively primitive means of fabrication, radial turbines are capable of extracting a large per-stage shaft work in small mass-flow rate situations. This turbine category also offers little sensitivity to tip clearances, in contrast to axial-flow turbines. Nevertheless, the turbine large envelope, bulkiness, and heavy weight (Figure 10.1) virtually prohibits its use in propulsion devices.