Implementation of Teach-Back for Discharge Teaching in a Critical Access Hospital: A Quality Improvement Project

A lack of comprehension of discharge instructions may cause high readmission and emergency room revisit rates for organizations. At the project site, there was no current evidence-based practice to ensure patient comprehension of discharge instructions. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the implementation of the Institute for Healthcare Improvement (IHI) Always Use Teach-Back Toolkit would impact emergency room revisit rates among adult medical-surgical patients in a critical access hospital in rural Minnesota over four weeks. Afaf Meleis’ transitions theory and the Iowa model for evidence-based practice were the scientific underpinnings of the project. The total sample size was 87, n = 47 in the comparison and n = 40 in the intervention groups. Data was extracted from the facility’s electronic health record. A chi-squared test was used, and results indicated no statistically significant reduction in the ED revisit rates X 2 (1, n=87) =2.00, p=0.157. Clinical significance is found in reducing the ED revisit rates by 1.38% over the four weeks. Therefore, the implementation of the IHI’s Always Use Teach-Back Toolkit may reduce emergency room revisit rates in this population and setting. Recommendations include sustaining the practice, adding teach-back to the discharge planning protocol, and disseminating the project findings

Alteration of Nucleotide Excision Repair by Estrogens: Implications for Carcinogenesis

Estrogens and estrogen mimics represent a wide range of aquatic contaminants that elicit deleterious effects on exposed organisms. Despite well-characterized reproductive effects of environmental estrogens, less is known about non-reproductive impacts of exogenous estrogen exposure. Additionally, estrogens are known carcinogens, implicated in multiple human cancers. Little or no research has examined the effects of xenoestrogens on DNA repair despite being known carcinogens. The goal of this research was to test the hypothesis that aquatic estrogens enhance the effects of environmental mutagens by altering DNA repair. Of particular interest is nucleotide excision repair (NER), the only repair pathway to remove structurally diverse DNA lesions that cause helical distortion, such as DNA adducts caused by ubiquitous environmental carcinogens. Research presented here shows that 17α-ethinylestradiol (EE2), a semi-synthetic hormone found in most oral contraceptives, alters hepatic mRNA levels of several key NER genes including XPC, XPA, XPD and XPF in adult male and female zebrafish exposed to environmentally relevant concentrations. Physiologically relevant concentrations of EE2 suppressed rate and magnitude of bulky adduct repair in zebrafish liver (ZFL) cells. This suppression of repair capacity in ZFL cells was not ameliorated in the presence of a complete estrogen receptor antagonist, which is known to antagonize the zebrafish estrogen receptor esr1. In adult zebrafish co-exposed to EE2 and benzo(a)pyrene (BaP), a prototypic polycyclic aromatic hydrocarbon and bulky adduct forming mutagen, hepatic mRNA levels of XPC and XPA were increased in comparison to fish exposed to EE2 alone. Regardless of hepatic NER transcript levels, fish co-exposed to EE2 and BaP exhibited increased BPDE-DNA adduct levels in comparison to both controls and fish exposed to BaP alone. In addition to single chemical exposures, adult zebrafish exposed to wastewater treatment effluent, a significant source of aquatic estrogens, exhibited altered NER transcript levels and decreased NER capacity. Collectively, this has significant implications for aquatic organisms living in contaminated environments, indicating the potential for higher mutation rates and increased neoplastic transformation with estrogen co-exposure than would be expected with mutagens alone. This research also presents an additional carcinogenic mode of action for estrogens, alteration of DNA repair

An Investigation of the Ability of an Individual to Perceive the Needs of Others in a Group Setting

The study of group dynamics has always been fascinated to those interested in a group setting. While much as been done in this area, a still larger amount of knowledge lies un-sorted and mysterious in the realm of group behavior. When, and specifically, when one who transmits enthusiasm and a guiding hand to a group, attempts to understand its workings, dynamics enter the group. A group has been defined as the meeting of a number of people and their subsequent interaction1. Admittedly, social interaction does take place in a group, if the above definition is accepted. This interaction has to do with a variety of complex elements, not the least of which is the need factor. This need factor is present within each individual within a group2. To be sure, each person attempts group interaction to satisfy his own sometimes critical, sometimes passing needs. How well the individual mingles his inner self with the inner selves of the rest of the group will, it seems, determine to what extent social development or maturing takes place. This area of group work is doubly fascinating. One can hardly dissect a group as one would the subject in a biological experiment. Then too it seems, that in a group there are so many intangibles, one can only get at what really goes on and why, by implication. Too many of the respected authors have put in to many hours of diligent labor on the subject of groups for anyone to suggest that there is not an indescribable something at work in the group process. Perhaps, little by little, the mysteries surrounding what the interaction in a group-setting is really all about, may be avoided. At any rate, it will be a burden of this investigation to look at one segment of this interaction. Having made some observations through the use of suitable instruments, it may then be possible to tabulate some results, if not conclusions. One thing which deserves mention is the fact that lack of knowledge and understanding concerning group processes exists. The writer has spoken to counselors who lamented the fact that group work has been so much misunderstood3. It seems that the purposes of continuing research in areas of group work are not done for the sole enhancement of researchers. Perhaps one may be so bold as to suggest that such research may help the doubtful gather new insights. Ancillary to such effects, it perhaps also aids those directly concerned with group dynamics, to formulate their own theories of such dynamics in a manner more acceptable to themselves and society

Notch Filtering Suitable for Real Time Removal of Power Line Interference

This paper presents a high performance notch filtering for real time suppression of power line interference in a general signal. The disturbing signal is suppressed using an optimal notch FIR filter with tunable notch frequency. The tuning of the filter preserves its selectivity, most importantly the specified attenuation at the notch frequency. One example and two Matlab functions demonstrate the performance, robustness and usefulness of the proposed procedure for the design and tuning of optimal notch FIR filters suitable in the real time notch filtering

A Study Examining the Effectiveness of a Sensory-Based Feeding Group for Children with Problematic Eating Behaviors

KEY WORDS: children, problematic eating behaviors, sensory, intervention OBJECTIVE: The purpose of this pilot study was to analyze the process and outcomes of a routine sensory-based feeding group on a child’s problematic eating behaviors. METHODS: An experimental pretest-posttest research design was used to gather and analyze quantitative and qualitative data on 4 children who demonstrated problematic eating behaviors. The children participated in a routine 8-week sensory-based feeding group, which utilized sensory activities to promote change. The Children’s Eating Behavior Inventory (CEBI) and the Feeding Intake Form (FIF) were completed through parental report prior to and upon completion of the intervention. Analysis focused on decreased problematic eating behaviors and improved behaviors during mealtimes. FINDINGS: As a result from the CEBI, 50% of children experienced a decrease in total eating score and 1 out of 4 parents reported a decrease in their child’s problematic eating behaviors. Fifty percent of parents reported less fighting about feeding during mealtimes, as concluded by FIF results. Children also became comfortable with the routine of the intervention and all children made improvements along the food continuum. CONCLUSIONS: Problematic eating behaviors impact a child’s growth and development and can interrupt family dynamics and mealtime routines. Based on results from this pilot study, a sensory-based feeding group has the potential to decrease a child’s problematic feeding behaviors and improve mealtime experiences through parental and child participation. These results are beneficial to improve interventions provided by pediatric occupational therapists

A new boundary element approach of modeling singular stress fields of plane V-notch problems

In this paper, a new boundary element (BE) approach is proposed to determine the singular stress field in plane V-notch structures. The method is based on an asymptotic expansion of the stresses in a small region around a notch tip and application of the conventional BE in the remaining region of the structure. The evaluation of stress singularities at a notch tip is transformed into an eigenvalue problem of ordinary differential equations that is solved by the interpolating matrix method in order to obtain singularity orders (degrees) and associated eigen-functions of the V-notch. The combination of the eigen-analysis for the small region and the conventional BE analysis for the remaining part of the structure results in both the singular stress field near the notch tip and the notch stress intensity factors (SIFs). Examples are given for V-notch plates made of isotropic materials. Comparisons and parametric studies on stresses and notch SIFs are carried out for various V-notch plates. The studies show that the new approach is accurate and effective in simulating singular stress fields in V-notch/crack structures

Notch activation is required for downregulation of HoxA3-dependent endothelial cell phenotype during blood formation.

Hemogenic endothelium (HE) undergoes endothelial-to-hematopoietic transition (EHT) to generate blood, a process that requires progressive down-regulation of endothelial genes and induction of hematopoietic ones. Previously, we have shown that the transcription factor HoxA3 prevents blood formation by inhibiting Runx1 expression, maintaining endothelial gene expression and thus blocking EHT. In the present study, we show that HoxA3 also prevents blood formation by inhibiting Notch pathway. HoxA3 induced upregulation of Jag1 ligand in endothelial cells, which led to cis-inhibition of the Notch pathway, rendering the HE nonresponsive to Notch signals. While Notch activation alone was insufficient to promote blood formation in the presence of HoxA3, activation of Notch or downregulation of Jag1 resulted in a loss of the endothelial phenotype which is a prerequisite for EHT. Taken together, these results demonstrate that Notch pathway activation is necessary to downregulate endothelial markers during EHT

Analysis of Various Chevron Notch Types and its Influence on the Ligament Area

Specimens for the bending tests with the chevron notch are standardized for the evaluation of the fracture toughness of various materials. In this contribution a difference of the ligament area of the specimens with the straight through notch and the chevron notch was investigated

Notch signaling during human T cell development

Notch signaling is critical during multiple stages of T cell development in both mouse and human. Evidence has emerged in recent years that this pathway might regulate T-lineage differentiation differently between both species. Here, we review our current understanding of how Notch signaling is activated and used during human T cell development. First, we set the stage by describing the developmental steps that make up human T cell development before describing the expression profiles of Notch receptors, ligands, and target genes during this process. To delineate stage-specific roles for Notch signaling during human T cell development, we subsequently try to interpret the functional Notch studies that have been performed in light of these expression profiles and compare this to its suggested role in the mouse