Background:A newly opened Medical Intensive Care Unit identified variation in nursing documentation practices related to titratable medications, with underlying causes initially unclear.Objectives:The primary aim of this quality improvement initiative was to reduce variation in titratable medication documentation practices by identifying and addressing barriers to compliance.Methods:Using an improvement science approach informed by protocol-based care and iterative Plan-Do-Study-Act cycles, the project identified key barriers, including workflow inefficiencies, documentation complexity, and knowledge gaps. A targeted educational intervention was subsequently developed, and auditing tools were used to assess sustainability.Results:Following the intervention, compliance with titratable medication documentation improved from a baseline of 78.5% to 88.7%, as demonstrated by audits conducted 3 months postintervention. Pre- and postclass surveys also showed significant improvements in nurses' confidence and competence in documenting and managing titratable medications.Discussion:This project provides insight into the development of collaborative, data-driven educational interventions that foster accountability, enhance clinical documentation practices, and ultimately improve patient safety and care quality in critical care settings. Future quality improvement efforts may benefit from incorporating simulation-based strategies.
Background: Poverty is defined as the lack of adequate resources to meet basic needs. Poverty is considered an early life stress (ELS) that is linked to the development of kidney disease during adulthood, showing sex differences. The underlying mechanisms remain unclear, although oxidative stress and autonomic activity may be involved. To evaluate the alterations in renal function, oxidative stress, and autonomic activity in adults exposed to ELS, our lab utilizes the limited bedding and nesting (LBN) rodent model. This model induces chronic stress by reducing bedding and nesting material from postnatal days 2-9. We hypothesize that LBN males will have a reduced glomerular filtration rate (GFR), increased circulating oxidative stress, and increased sympathetic nerve activity (SNA): parasympathetic nerve activity (PNA), while LBN females will show no changes in these variables. Methods: After exposure to the LBN or control (CON) condition, pups were weaned and separated by sex and condition. During adulthood (17-24 weeks), SNA and PNA were recorded. Autonomic activity was examined by the ratio of SNA:PNA, measured by low frequency blood pressure variability (LF BPV) and high frequency heart rate variability (HF HRV). Following the recording, GFR was evaluated via FITC-sinistrin. Hydrogen peroxide (H 2 O 2 ), a marker of oxidative stress, was measured via a biochemical assay, using plasma. Results: GFR was reduced by ~34% in LBN vs. CON males (0.89 ± 0.12 vs. 1.35 ± 0.08 mL/min/100g body weight, p=0.004), while GFR in LBN females remained unchanged (ns). Exposure to the LBN condition increased circulating H 2 O 2 in both males and females (F (1, 24) = 5.74, p=0.02). However, compared to the same sex CONs, LBN males displayed a greater, 17%, upward trend in H 2 O 2 (1.15 ± 0.08 vs. 0.98 ± 0.02 nMol, p=0.07), whereas LBN females only displayed a modest, nonsignificant, increase in H 2 O 2 (1.16 ± 0.03 vs. 1.04 ± 0.06 nMol, ns). The ratio of SNA:PNA was elevated in both LBN males and females (F (1, 16) = 8.685, p=0.01). Surprisingly, LBN vs. CON males displayed a 3-fold increase (2.73 x 10-4 vs. 9.11 x 10-5 A.U., p=0.05) and LBN vs. CON females exhibited a 10-fold increase (2.73 x 10-4 vs. 2.23 x 10-5 A.U., p=0.05). Conclusion: Resource scarcity during weaning induces sex differences in renal function, circulating oxidative stress, and autonomic activity in adult rats. Both males and females exposed to LBN have increased oxidative stress and autonomic activity, although the degree of severity differs. LBN males displayed a greater increase in oxidative stress, while LBN females showed a greater increase SNA: PNA activity. Only LBN males revealed a reduction in renal function. Therefore, in this model of ELS, oxidative stress may play a more critical role in reducing renal function, as demonstrated by LBN males. Future studies will explore the impact oxidative stress in LBN males to cause renal dysfunction. Additionally, future studies will address why LBN females may be experiencing renal protection, despite an increase in the autonomic ratio seen in both sexes. Researching these pathways can provide insight into how ELS leads to long-term health disparities between sexes. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.
Breast cancer surgery results in significant postoperative pain. Pectoral nerve blocks (PECS I and II) may lessen the use of opioids during surgery and enhance pain management. This systematic review and meta-analysis assessed the efficacy of PECS blocks compared with placebo in breast cancer surgery. The Cochrane Collaboration, PubMed, CINAHL, Google Scholar, and grey literature were all thoroughly searched. We only included randomized controlled trials (RCTs) that compared PECS I or II blocks to a placebo. Mean differences (MD) and risk ratios (RR) were calculated for primary and secondary outcomes. Meta-analysis was conducted using RevMan 5.4, and evidence was appraised using the GRADE system. Twenty-two RCTs were included. PECS blocks significantly decreased pain scores up to 48 hours after surgery during activity (MD, -1.66) and at rest (MD, -1.38). Additionally, they decreased the use of opioids during surgery (MD, -5.28) and after surgery (MD, -9.82), extended the time until first rescue analgesia (MD, 4.95 hours), and decreased PONV (RR, 0.48) with no effect on chronic pain (RR, 0.40). PECS blocks support their role in multimodal analgesia by improving postoperative pain control, lowering the need for opioids, and promoting recovery following breast cancer surgery.
This case study explores retirement and health plan decisions faced by many students who are newly hired as full-time employees. Students are drawn into the storyline of two former college classmates and friends as one accepts a full-time position after graduation and the other seeks a master's degree in accounting. The accounting student takes on the role of a consultant to research retirement and health plan options, calculate the impact on take-home pay, and estimate taxable income and related taxes. Learning objectives for the case include understanding how the tax consequences differ between retirement plans, explaining the attributes of a health savings account (HSA) and related health plans, evaluating the ramifications of tax planning alternatives for retirement and health plans, and communicating tax research and recommendations through written documentation.
Context. Behaviour-Driven Development (BDD) test suites accumulate duplicated step subsequences. Three published refactoring patterns are available (within-file Background, within-repo reusable-scenario invocation, cross-organisational shared higher-level step), but no prior work automates which recurring subsequences are worth extracting or which mechanism applies. Objective. Rank recurring step subsequences ("slices") by refactoring suitability (extraction-worthy), pre-map each to one of the three patterns, and quantify prevalence across the public BDD ecosystem. Method. Every contiguous L-step window (L in [2, 18]) in a 339-repository / 276-upstream-owner Gherkin corpus is keyed by paraphrase-robust cluster identifiers and counted under three scopes. SBERT / UMAP / HDBSCAN clustering recovers paraphrase-equivalent slices. Three authors label a stratified 200-slice pool against a written rubric. An XGBoost extraction-worthy classifier trained under 5-fold cross-validation is compared with a tuned rule baseline and two open-weight Large Language Model (LLM) judges. Results. The miner produces 5,382,249 slices collapsing to 692,020 recurring patterns. Three-author Fleiss' kappa = 0.56 (extraction-worthy) and 0.79 (mechanism). The classifier reaches out-of-fold F1 = 0.891 (95
