Central Texas College

The objective of this review was to evaluate the effect of intravenous dexamethasone given intraoperatively for postoperative nausea and vomiting prophylaxis on maximal blood glucose level within the initial 24 hours following elective surgery for patients with diabetes. Postoperative nausea and vomiting is a prevalent adverse effect of anesthesia that leads to morbidity, increased health care costs, and unanticipated hospital admissions. Dexamethasone is an effective prophylactic agent that confers secondary analgesic and anti-inflammatory benefits. However, its use in patients with diabetes remains controversial due to the potential for increased postoperative blood glucose levels. This review considered studies with participants 18 years of age or older with type 1 or 2 diabetes undergoing an elective surgical procedure. Eligible studies reported postoperative blood glucose levels in adults with diabetes after receiving a single 4-10 mg prophylactic dose of intravenous dexamethasone intraoperatively for postoperative nausea and vomiting. The primary outcome was maximum blood glucose level in the first 24 hours after surgery. All study designs were eligible for inclusion. Studies were excluded if they lacked a control group with diabetes or if they did not report maximum blood glucose values in both groups. A search of MEDLINE, CINAHL Complete, Embase, Web of Science, TRIP database, and the Cochrane Database of Systematic Reviews was completed in October 2021. Gray literature resources were also searched. No date or language restrictions were applied. Methodological quality was assessed using JBI appraisal tools for randomized controlled trials, cohort studies, and case-control studies. A meta-analysis of maximal postoperative blood glucose level within 24 hours of surgery was performed, as well as subgroup analyses by dexamethasone dose, insulin treatment, and study design type. Eleven studies (4 randomized controlled trials, 6 cohort studies, and 1 case-control study) were included in this review, with 1 study excluded from meta-analysis and results reported narratively. The total sample size of studies included in meta-analysis was 2567. The administration of dexamethasone significantly increased maximal blood glucose levels in the 24 hours immediately following surgery compared with control groups with diabetes, as demonstrated by randomized controlled trials (mean difference [MD] 39.56 mg/dL; 95% CI 16.18 to 62.94; P < 0.001; I2 = 87%) and observational studies (MD 26.31 mg/dL; 95% CI 7.10 to 45.52; P = 0.007; I2 = 92%). This increase in blood glucose was significant for all doses of dexamethasone: 4 mg (MD 40.81 mg/dL; 95% CI 2.42 to 79.19; P = 0.001; I2 = 91%), 8 mg (randomized controlled trials only; MD 39.45 mg/dL; 95% CI 15.32 to 63.58; P = 0.001; I2 = 86%), and mixed 4-10 mg dose (MD 30.82 mg/dL; 95% CI 6.75 to 54.88; P < 0.012; I2 = 93%). Postoperative hyperglycemia persisted in studies using insulin treatment as well as those not using insulin protocols. The overall certainty of the findings ranged from very low for outcomes that included cohort studies to moderate when outcomes from randomized controlled trials were analyzed separately. However, the quantitative findings of the experimental and observational studies were clinically similar. Risk of bias presented minimal concerns in all included studies. Dexamethasone leads to transient postoperative hyperglycemia in patients with diabetes undergoing elective surgery when given as a single 4-10 mg intravenous dose for postoperative nausea and vomiting prophylaxis. The clinical relevance of hyperglycemia is debatable given its small magnitude and transient nature. Without more tightly controlled data, methodological consistency, and baseline blood glucose values, it is impossible to test causal links between hyperglycemia and pre-existing patient factors (eg, hemoglobin A1C levels) or postoperative complications. PROSPERO CRD42020185607.

Leadership is a popular area of study but appears to be locked within a never-ending loop of retroactive behavioral analysis. Field theory offers modern leadership study an opportunity to break this cycle, potentially unlocking previously undiscovered relationships within the leadership phenomenon. The authors evaluate field theory for Christian application via Trentham’s principle of inverse consistency. After reorientation toward a Christian worldview, field theory is demonstrated as a valid theoretical construct to inform Christian leadership praxis.

The June 1941 German invasion of the Soviet Union unleashed a series of events that culminated in the Allied invasion of Iran two months later. In their propaganda, Britain and the Soviet Union publicly justified that invasion as a means of preventing Iran from falling into the German orbit. However, a review of radio broadcasts of the time shows the theme of a German menace was not widely believed in the region. Using BBC Summary of World Broadcasts transcripts from the period, this paper argues that the decision to base their propaganda on a lie also negatively affected relations in the postwar world. In that sense the decision to justify the invasion on the basis of German presence was a propaganda failure for the allies.

CSin3 is a cohort-based, three-year computer science bachelor's degree program that has increased graduation rates of traditionally underrepresented computer science students. A collaborative effort between a community college and a public university, CSin3 provides a clear pathway for upward socio-economic mobility into the high-paying technology industry. CSin3 students are 90% from traditionally underrepresented groups, 80% first-generation, 32% female, and have a three-year graduation rate of 71%, compared to a 22% four-year graduation rate for traditional computer science students. Upon graduation, CSin3 students score similarly on a standardized exam of computer science knowledge as compared to traditional students who graduate in 4 years or more. The first graduates had a job placement rate of 78% within two months of graduation, including positions at large technology companies like Apple, Salesforce, and Uber. By implementing a cohort-based learning community, a pre-defined course pathway, just-in-time academic and administrative support, comprehensive financial aid, and a focus on 21st century skills, the CSin3 program has demonstrated promising results in addressing the capacity, cost, quality, and diversity challenges present in the technology industry.

The objective of this handbook is to make available in a quick reference form, the information to enhance and support the response capabilities of firefighters, emergency medical technicians, hazardous materials response teams, law enforcement officers, bomb squads, medical doctors and nurses, emergency managers, schools, and others. This handbook is dedicated and committed to disaster prevention, preparedness, readiness, response, mitigation and recovery efforts. This is an ideal book for newcomers to the field, and can be used for fast knowledge for application to any areas of response.

This study focused on discovering servant leadership in the nonprofit organization (NPO) of the church with a concentration on new follower relations. The investigation was conducted as an Interpretative Phenomenological Analysis (IPA) so as to be able to capture the life experiences and identifications of the servant leaders in the church clergy. Servant leadership theory is a management model and practice for the business community including large organizations, such as Southwest Airlines, to small businesses and to NPOs, including the church. The problem is the lack of clarity on how clear servant leaders in NPOs cultivate relationships with new followers and empower them to develop a caring community while meeting the NPO’s needs. The researchers investigated the experiences of servant leaders to receive and develop new follower relations in the NPO of the Christian Protestant church. The research revealed a potential lack of clarity and the need for specific research on new followers focused on the initial concept of servant leadership; the definition of a servant leader is a leader who serves first. The participants in this study were servant leader pastors from Christian churches in the Northern United States. Two research questions were developed to inquire, first, about how the participant’s actions were received when they were new followers and secondly, to inquire about the participants’ servant leader undertakings toward their new followers. The data were analyzed and superordinate themes were developed based on data provided by the interviews and the derived interlocking information produced. The resulting superordinate theme for research question one was “Commitment to the Growth of People.” The superordinate themes for research question two were “Empowering and Developing People” and “Providing Direction.” The results from the interviews and double hermeneutic analysis demonstrated that the servant leader participants taught new followers first and then, once the new follower attained a sufficient basic level of knowledge, were served by these servant leaders. Scholars highly regard the historical individual known as Jesus of Nazereth as one of the original servant leaders and his teachings to his disciples as prime examples of servant leadership guidelines. The generalizability of the research relates to any new follower who receives little to no screening in any organization, like the selected group of the NPO of the church, a secular NPO like the United Way, or a standard business which increases its workforce with little screening. The conclusions of this research study added to the extent information on servant leadership theory. This study can serve as a catalyst for future research regarding new followers using servant leadership.