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You will be asked to address the anticipated results in your application. If you receive a grant, you will be asked to provide evidence of those results at the end of your project. You will need to describe the participants' learning, the composition of the participant group, and the numbers of participants and activities, as well as the activities used to facilitate the acquisition of knowledge or skills in the arts. If you receive support through the Arts Education discipline for a standards-based project, you will be required to report on additional measurable results, including identifying specific learning outcomes, describing the assessment method, and reporting on the number of participants who demonstrated learning. Before applying, Christian Louboutin Metallika Ankle Booties outlet limited edition footlocker online discount wide range of eTeSFkhJpZ
. In addition to a Final Descriptive Report and Federal Financial Report, Arts Education grantees who apply for a Direct Learning Grant will be required to describe the methods used to assess learning, and they will be required to submit any tools used to assess learning with their Final Report.

please review the reporting requirements for Learning

Support is available for projects that incorporate the arts and design into strategies to improve the livability of communities. Livability consists of a variety of factors that contribute to the quality of life in a community such as ample opportunities for social, civic, and cultural engagement; public safety; affordable housing and ease of transportation; and an aesthetically pleasing environment. The arts can enhance livability by providing new avenues for expression and creativity. Arts- and design-related Livability activities may include:

Please note that certain types of Livability activities will require applicants to provide information in accordance with the National Environmental Policy Act and/or the National Historic Preservation Act . See for more information.

The anticipated long-term results for Livability projects are measurable community benefits, such as growth in overall levels of social and civic engagement; new avenues for expression and creativity; design-focused changes in policies, laws, and/or regulations; job and/or revenue growth; or positive changes in migration patterns. You will be asked to address the anticipated results in your application. If you receive a grant, you will be asked to provide evidence of those results at the end of your project. Given the nature of Livability projects, benefits are likely to emerge over time and may not be fully measureable during the period of a grant. You will need to provide evidence of progress toward achieving improved livability as appropriate to the project. Reporting requirements for Livability are different from -- and more extensive than -- the reporting requirements for the other outcomes. Before applying, please review the reporting requirements for Livability .

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Focus on…Critical Care
Back to Focus on…Critical Care
May 2017 Vol. 12 No. 5

Author: Krista Williamson, BSN, CMSRN, CNML; Lorie Gonzalez, MSN, BC-RN; Ashley Neusbaum, MSN, CMSRN; and Jaime Messing, BSN, RN

A lthough the incidence of central line–associated bloodstream infections (CLABSIs) has decreased, the Centers for Disease Control and Prevention reports that an estimated 30,100 of these infections still occur in the United States each year, resulting in thousands of deaths and adding up to billions in costs. To reduce CLABSIs, nurses need to address quality-control issues and make prevention a daily task.

At Penn State Hershey Medical Center, our 49-bed medical-surgical unit uses central lines for posttransplant medications, I.V. vesicants and antibiotics, and total parenteral nutrition. The unit averages 230 central line patient days per month. To address the issue of CLABSIs, we convened an interprofessional team of nurses, physicians, phlebotomists, and infection prevention experts to implement guidelines and recommendations to reduce central line access. The team collaborated to create the No Central Blood Line Draw program. We used the Plan-Do-Check-Act quality-improvement model to implement changes in physician ordering practices, phlebotomy and nursing workflow, patient education, and charge nurse competency in central line blood draws.

How it works

The unit’s education council members designed an education plan, which included teaching all staff about the risks for infection when a central line is accessed. Charge nurses, the only nurses permitted to perform blood draws from central lines, reviewed the relevant policy and received specialized training in this and capillary blood sampling. Laboratory and phlebotomy staff implemented laboratory specimen bundling and explained the process to staff. Collection times occur every 4 hours beginning at 4 A . M . Any specimens ordered between these collection times are drawn on the next collection cycle. Exceptions include admission laboratory specimens, coding or critically ill patients, stat blood cultures, blood cultures ordered before initiating antibiotics, drug monitoring that occurs at nonstandard lab times, and specimens needed after a blood product transfusion.

Nurses evaluate all patients with a central line for their willingness to participate in the No Central Blood Line Draw program. Patients naturally prefer having blood drawn from a central line to being “stuck” with a needle, so we teach them about the relationship between accessing central lines for blood specimens and the risk of infection with each occurrence. We also developed a patient education handout describing CLABSIs, strategies used to prevent them, and how patients can participate in their own care. (See Keeping you safe .)

Figure 1 BITA grafts for triple vessel disease. RITA is grafted to the LAD coronary artery, while LITA passes laterally to the circumflex marginal branch. RA graft is sutured to the distal RCA. BITA, bilateral internal thoracic artery; LAD, left anterior descending artery; LITA, left internal thoracic artery; RA, radial artery; RCA, right coronary artery; RITA, right internal thoracic artery

An alternative technique is to anastomose the LITA to the LAD, and if required, to a diagonal branch using either a sequential or Y-graft technique. Sequential grafting is only satisfactory when the diagonal branch lies adjacent to the LAD, thus avoiding a large loop of LITA which may angulate and thus compromise the distal anastomosis. A better technique is to use a short segment of additional arterial graft in a Y configuration from the LITA to the diagonal branch. This is a more flexible solution, allows for any diagonal location, and permits the LITA to find its own lie more easily without kinking when the chest is closed. With this strategy, the in situ RITA may be passed through the transverse sinus and anastomosed to the marginal branch of the circumflex system with the potential for a Y graft of radial artery off this to a second marginal target. Occasionally the RITA may be more easily brought anteriorly across the midline—behind the thymus as in the above description—to reach an intermediate or very proximal marginal branch. The reconstruction is then completed with a RA graft to the posterior descending branch ( Joie Suede Patchwork Booties cheap sale websites cheap hot sale 405pszzxf
). This technique is popular with some surgeons although it is difficult to visualize the entire length of the artery and any bleeding sites as it passes through the transverse sinus to the left system, and the posteriorly placed RITA may be difficult to control at reoperation.

Figure 2 LITA is grafted to the LAD. A short length of the RA is sutured to the LAD as a Y-graft for the diagonal branch. RITA passes through the transverse sinus and is grafted to the second circumflex marginal branch

A third option is for the LITA to be grafted to the LAD and a RA graft to the circumflex system. The in situ RITA may be anastomosed to the main right coronary artery or to the terminal branches of the right coronary artery (RCA) using a graft extension technique. A RITA-RA graft extension may terminate in a single distal anastomosis or as a sequential graft with a side-to-side anastomosis to the posterior descending artery (PDA) and an end-to-side anastomosis with the posterolateral branch ( Figure 3 ). In situ RITA grafts to the main RCA have suboptimal patency in both our experience and that of others, and this configuration, although technically simple and convenient, is not widely preferred.

Figure 3 LITA is grafted to the LAD, RA to the circumflex marginal coronary artery. The composite RITA and radial artery extension terminates in posterior descending and posterolateral sequential graft

When BITAs are contraindicated, or in the very elderly, a total arterial reconstruction can be performed safely in almost all patients using the LITA to the LAD, supplemented by bilateral RA grafting to the circumflex system and to the RCA. This use of bilateral RAs is well tolerated in elderly patients in whom extensive SV graft disease is common. Avoiding the long SV avoids leg trauma and promotes early mobilization ( discount low shipping fee clearance online cheap real Oscar de la Renta Metallic PointedToe Flats 3EaUrcI



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