Role of pump prime in the etiology of cardio-pulmonary bypass associated acidosis

The development of metabolic acidosis during cardio-pulmonary bypass (CPB) is a well recognized but poorly explained phenomenon. It has been hypothesized that it is purely a development after the delivery of pump prime. A retrospective study was conducted at our hospital on 68 patients who underwent elective coronary artery bypass grafting (CABG). Sampling of arterial blood was performed at three time intervals: (T₁) Baseline, prior to induction; (T₂) 5 minutes after initiation of CPB and prior to administration of cardioplegia solution; (T3) during rewarming prior to weaning the patient off CPB. Measurements of Na⁺, K⁺, Cl⁻, pH, pCO₂, HCO₃ ⁻, Base excess, Anion gap, Strong ion difference at each collection point were performed. Results were analyzed in a quantitative manner. On delivery of pump prime, all patients' developed metabolic acidosis. However, it is very important to distinguish the metabolic acidosis as their management varies. Anion gap has been found to be useful in managing peri-operative metabolic acidosis.     

Fostering innovation through collaborative action research on the creation of shared instructional products by university science instructors

ABSTRACT

The purpose of this study is to profile four university science instructors who utilized action research as a means of learning how to develop and integrate a novel curriculum innovation – engineering design – in their science courses. Data included curriculum maps, lesson plans, notes from group meetings, and instructor reflections. Data analysis included document review and content analysis. Findings from this study suggest that action research effectively enabled the instructors to 1) establish shared ownership of the project goal – to improve preservice teachers’ learning of science through engineering design; 2) continuously test, revise, and recalibrate their shared instructional products; and 3) leverage multiple sources of innovation. Knowledge generated and used by the instructors represented different kinds of knowledge and distributed expertise resulting in products that were more useful and of higher quality than products created by individuals working alone. Consequently, this resulted in increased use of the products and increased instructor commitment to improve them over time. By simultaneously engaging in research and consequently taking specific action to inform their practice, science instructors in this study successfully created shared instructional products that both guided and enhanced their classroom teaching.     

Arterial blood gas management during cardiopulmonary bypass

This study sought to investigate the effects of α-stat and pH stat regimens on cardiac outcome during moderate hypothermic cardiopulmonary bypass. 100 patients undergoing elective coronary artery bypass grafting (CABG) were randomly assigned with respect to the target value for PaCO₂ during cardiopulmonary bypass (CPB) into 2 groups. In 50 patients the target PaCO₂ was 40 mmHg, measured at a standard electrode temperature of 37°C while in the other 50 patients the target PaCO₂ was 40 mmHg, corrected to the patients nasopharyngeal temperature (lowest value reached: 32±0.5°C). There were no significant differences between groups with regards to cardiac outcome such as appearance of new ‘Q’ waves on the electrocardiogram, postoperative creatinine kinase-MB fraction, systemic vascular resistance (SVR), cardiac index (Cl), need for inotropic or intra-aortic balloon pump support and the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO₂ management during CPB at moderate hypothermia has no clinically significant effect on cardiac outcome.     

Serum gamma glutamyl transpeptidase in breast cancer

Gamma-glutamyl transpeptidase (gamma-GT) levels were estimated in the sera of patients with breast cancer and compared with those of benign breast diseases and healthy controls. Serum gamma-GT levels were found to be significantly increased in patients with breast cancer compared to the controls as well as benign breast diseases. The rise however, was nearly same in all the patients irrespective of histopathology of cancer but was directly related to tumour mass. After mastectomy the levels remained higher upto 3 months. In patients with cancer the rise in serum gamma-GT was significantly higher as compared to those with benign breast diseases. Although gamma-GT is an index of liver diseases, its high level in breast carcinoma suggests the release of the membrane bound constituents from different tissues even in carcinoma.     

The Role of Ethnic Identity,Gender Roles,and Multicultural Training in College Counselors' Multicultural Counseling Competence: A Mediation Model

Structural equation modeling with survey data from 313 college counselors revealed that multicultural training significantly mediated the impact of both ethnic identity and gender roles on multicultural counseling competence (MCC), explaining 24% of MCC variance. Results indicated that college counselors need to be aware of their own gender roles and ethnic identity to be culturally competent and highlighted the mediational role that training plays in achieving MCC.     

Ethnic and Racial Identity During Adolescence and Into Young Adulthood: An Integrated Conceptualization

Although ethnic and racial identity (ERI) are central to the normative development of youth of color, there have been few efforts to bring scholars together to discuss the theoretical complexities of these constructs and provide a synthesis of existing work. The Ethnic and Racial Identity in the 21st Century Study Group was assembled for this purpose. This article provides an overview of the interface of ERI with developmental and contextual issues across development, with an emphasis on adolescence and young adulthood. It proposes a metaconstruct to capture experiences that reflect both individuals’ ethnic background and their racialized experiences in a specific sociohistorical context. Finally, it presents milestones in the development of ERI across developmental periods.     

Decentralization of First Nations Education in Canada: Perspectives on Ideals and Realities of Indian Control of Indian Education

Fuelled by the concept of self-determination, efforts to improve schooling under the banner of decentralization are taking hold in First Nations communities throughout Canada. Proponents of decentralization hold the perception that decentralized systems are more likely to improve education than centralized systems. But is there a chance that local control can improve First Nations education? From the point of view of the realization of the decentralization values, the outcome is uncertain at best and gloomy at worst. To the extent that First Nations are alert to the emerging educational needs and problems and strong enough to mobilize First Nations resources on their behalf, we may entertain a cautious optimism on the resolution of some of the manifold contradictions of decentralization. I contend that unless there is a genuine devolution that entails the empowerment of First Nations communities to provide an education that is specifically suited to each community, schools for Aboriginal children will remain mediocre in quality. If decentralization is to sustain its momentum and advance productively in coming years, at least it should meet three conditions. First, certain constraints or contradictions internal to decentralization will have to be resolved. Second, Aboriginal scholars and First Nations school authorities need to employ appropriate change strategies by providing a framework for local control, and finally, First Nations communities and federal authorities need to find the key symbolic and structural characteristics of decentralizing First Nations schools.     

Comparing first- and third-person perspectives in early elementary learning of honeybee systems

Prior literature has begun to demonstrate that even young children can learn about complex systems using participatory simulations. This study disentangles the impacts of third-person perspectives (offered by traditional simulations) and first-person perspectives (offered by participatory simulations) on children’s development of such systems thinking in the context of the emergent complexity of honeybee nectar foraging. Specifically, we worked with three first-grade classrooms assigned to one of three conditions—instruction through use of a first-person perspective only, third-person perspective only, and integrated instruction—to engage ideas of complex systems thinking. In each condition, systems concepts were targeted through instruction and assessment. The integrated and third-person classrooms demonstrated significant gains while the first-person classroom showed gains that were not statistically significant, suggesting that third-person perspectives play a critical role in how children learn systems thinking. This work also puts forth a novel assessment design for young children using multiple-choice questions.

     

SciEthics Interactive: science and ethics learning in a virtual environment

Learning in immersive 3D environments allows students to collaborate, build, and interact with difficult course concepts. This case study examines the design and development of the TransGen Island within the SciEthics Interactive project, a National Science Foundation-funded, 3D virtual world emphasizing learning science content in the context of ethical dilemmas. The 2 year development process is examined through the lens of the rapid prototyping instructional design model, following the project from conceptualization to implementation of a 3D simulation. Through expert interviews, focus groups, and working groups, we were able to determine critical scientific and ethical issues to present to learners in the virtual world. We collected data on 53 students using the simulation at universities in the United States and South Africa and evaluated their experience using qualitative and quantitative methods. Results showed that student participants were engaged and motivated by the simulation. The students reported an increase in science knowledge and ethical understanding, but individual experiences varied.