Factors That Contribute To Adverse Events Involving Care- Dependent Community Dwelling Older Adults And Their Caregivers.

The research on home and community care shows that when safely delivered it can be an efficient way to support elders who require care, potentially preventing a move into costlier institutional care. Learning from system-wide safety breakdowns that occur is necessary to establish appropriate prevention strategies. The purpose of this study was to identify the factors that contributed to adverse events in care-dependent community-dwelling older adults and their caregivers. Using a multiple case study methodology, eight falls were investigated using a comprehensive Systemic Falls Investigative Method. Using within case and across case analyses, a total of 280 contributing factors were identified, and grouped in four distinct themes of safety deficiencies: Everyday living has become risky, Limitations with supervision, Disconnects within the system, and Poor fall risk identification and follow-up. This study provides insights into how and why adverse events occur in home and community care, allowing for targeted systemic improvements

Describing the Falls Prevention Program at an Acute Care Hospital in Ontario Using Leveson’s Systems Model

Falls are the most frequent adverse event in acute care hospitals. Although a large number of studies have addressed the patients’ risk factors for falls and best practices in fall prevention, patients falls still remain a major problem. This study applied a systemic methodology (Causal Analysis based on STAMP (CAST)) to depict Ontario’s acute care hospital structure related to patient fall prevention. The system’s component behaviours and interactions were described and deficits and inappropriate control mechanisms among the system’s controllers were identified. As a result of the CAST analysis, the complexity of the health care system, lack of a consistent and clear fall prevention strategy, risk assessment tool and fall data analysis methodology, and effective communication between the controllers were identified as potentially problematic. Suggestions were offered to improve these gaps

Site Remediation Technology InfoBase: A Guide to Federal Programs, Information Resources, and Publications on Contaminated Site Cleanup Technologies. First Edition

Table of Contents: Federal Cleanup Programs; Federal Site Remediation Technology Development Assistance Programs; Federal Site Remediation Technology Development Electronic Data Bases; Federal Electronic Resources for Site Remediation Technology Information; Other Electronic Resources for Site Remediation Technology Information; Other Electronic Resources for Site Remediation Technology Information; Selected Bibliography: Federal Publication on Alternative and Innovative Site Remediation; and Appendix: Technology Program Contacts

Helium Ion Microscopy

Helium Ion Microcopy (HIM) based on Gas Field Ion Sources (GFIS) represents a new ultra high resolution microscopy and nano-fabrication technique. It is an enabling technology that not only provides imagery of conducting as well as uncoated insulating nano-structures but also allows to create these features. The latter can be achieved using resists or material removal due to sputtering. The close to free-form sculpting of structures over several length scales has been made possible by the extension of the method to other gases such as Neon. A brief introduction of the underlying physics as well as a broad review of the applicability of the method is presented in this review.Comment: Revised versio

Fall Prevention in an Acute Care Hospital: The Challenges Encountered by Patients, Staff and Administrators

Abstract Falls are frequent and often serious events that take place in hospitals. Healthcare providers find it challenging to minimize fall risk factors. In fact, just being in a hospital is a risk factor in itself! The aim of this thesis was to investigate the reasons behind patient falls, identify gaps in prevention strategies and suggest additional recommendations to improve patient safety. A mixed method approach was used to interpret the data and uncover the reasons for falls. The first study was a secondary data analysis where 7,721 patient falls were examined. The data were taken from the hospital’s central incident reporting system between 2009 and 2014. Most falls occurred in the medicine and neurosciences units. The highest frequency of falls (901) occurred between 10:00 a.m. and 12:00 p.m., a time when staff were generally preoccupied with multiple tasks. Although most falls were not serious, there were 2,275 falls resulting in an injury and 16 resulted in death as a result of the fall. These findings and others were the impetus to follow-up with the next study concentrating on the validity of the fall risk assessment tool. The second study was a predictive validity study examining 500 patient scores obtained from the Morse Falls Scale (MFS) on medicine units in the hospital. The MFS was used to assess patient risk for falling. Using a cut-off score of 25, the sensitivity was 98 percent, however, the specificity was only 8 percent. An MFS cut-off point of 55 provided the most balanced measure of sensitivity (87%) and specificity (34%) for accurate identification of fall risk, however still low. These results showed that a change on how the hospital assessed falls risk was indicated. The third study was a multiple case analysis of patient falls in the same acute care hospital. The findings from eleven cases from two previous studies were explored further to identify key contributing factors which led to the falls. Findings included inadequate hospital policies, lack of staff education and patient cognitive and mobility issues while in hospital. A change in practice across all defense layers was recommended. KEY WORDS Patient falls, hospital incident reporting systems, fall prevention strategies, falls risk assessment tools, patient fall case studie

Multispectral pansharpening with radiative transfer-based detail-injection modeling for preserving changes in vegetation cover

Whenever vegetated areas are monitored over time, phenological changes in land cover should be decoupled from changes in acquisition conditions, like atmospheric components, Sun and satellite heights and imaging instrument. This especially holds when the multispectral (MS) bands are sharpened for spatial resolution enhancement by means of a panchromatic (Pan) image of higher resolution, a process referred to as pansharpening. In this paper, we provide evidence that pansharpening of visible/near-infrared (VNIR) bands takes advantage of a correction of the path radiance term introduced by the atmosphere, during the fusion process. This holds whenever the fusion mechanism emulates the radiative transfer model ruling the acquisition of the Earth's surface from space, that is for methods exploiting a multiplicative, or contrast-based, injection model of spatial details extracted from the panchromatic (Pan) image into the interpolated multispectral (MS) bands. The path radiance should be estimated and subtracted from each band before the product by Pan is accomplished. Both empirical and model-based estimation techniques of MS path radiances are compared within the framework of optimized algorithms. Simulations carried out on two GeoEye-1 observations of the same agricultural landscape on different dates highlight that the de-hazing of MS before fusion is beneficial to an accurate detection of seasonal changes in the scene, as measured by the normalized differential vegetation index (NDVI)

Multidimensional Index Modulation for 5G and Beyond Wireless Networks

This study examines the flexible utilization of existing IM techniques in a comprehensive manner to satisfy the challenging and diverse requirements of 5G and beyond services. After spatial modulation (SM), which transmits information bits through antenna indices, application of IM to orthogonal frequency division multiplexing (OFDM) subcarriers has opened the door for the extension of IM into different dimensions, such as radio frequency (RF) mirrors, time slots, codes, and dispersion matrices. Recent studies have introduced the concept of multidimensional IM by various combinations of one-dimensional IM techniques to provide higher spectral efficiency (SE) and better bit error rate (BER) performance at the expense of higher transmitter (Tx) and receiver (Rx) complexity. Despite the ongoing research on the design of new IM techniques and their implementation challenges, proper use of the available IM techniques to address different requirements of 5G and beyond networks is an open research area in the literature. For this reason, we first provide the dimensional-based categorization of available IM domains and review the existing IM types regarding this categorization. Then, we develop a framework that investigates the efficient utilization of these techniques and establishes a link between the IM schemes and 5G services, namely enhanced mobile broadband (eMBB), massive machine-type communications (mMTC), and ultra-reliable low-latency communication (URLLC). Additionally, this work defines key performance indicators (KPIs) to quantify the advantages and disadvantages of IM techniques in time, frequency, space, and code dimensions. Finally, future recommendations are given regarding the design of flexible IM-based communication systems for 5G and beyond wireless networks.Comment: This work has been submitted to Proceedings of the IEEE for possible publicatio

The First Implementation of a Total Flight Test System in Former Yugoslav Flight Test Centre

This paper describes the overall system design and relevant performance characteristics of total Flight Test Instrumentation Systems (FTI) based on PCM/FM telemetry technique for aircraft testing first implemented in Former Yugoslav Flight Test Centre (FTC). Design and implementation of the FTI System is very important for successful evaluation of the testing prototype of vehicle. The system encompasses subsystems for airborne data acquisition and flight line check-out, a mobile ground telemetry system, and a fixed facility. The fixed facility includes a ground telemetry system for real time data processing and test control, and a data processing system for postflight analysis. The system represents a fully integrated approach to flight test systems which addresses the end-to-end requirements from airborne data acquisition and real time flight monitoring through aircraft performance and stability/control analysis. The architecture of the ground systems illustrates how preprocessing can be utilized to create powerful real time telemetry systems even with modest general purpose computer capability

Gradient-Based Multi-Component Topology Optimization for Manufacturability

Topology optimization is a method where the distribution of materials within a design domain is optimized for a structural performance. Since the geometry is represented non-parametrically, it facilitates innovative designs through the exploration of arbitrary shapes. Due to its unconstrained exploration, however, topology optimization often generates impractical designs with features that prevent economical manufacturing, e.g., complex perimeters and many holes. Above all, existing topology optimization methods assume that the optimized structure will be made as a single piece. However, structures are usually not monolithic (i.e., single-piece), but assemblies of multiple components, e.g., cars, airplanes, or even chairs. It is mainly because producing multiple components with simple geometries is often less expensive (i.e., better manufacturability) than producing a large single-piece part with complex geometries, even with the additional cost of assembly. This dissertation discussed a topology optimization method for designing structures assembled from components, each built by a certain manufacturing process, termed the MTO. The prior art of MTO used discrete formulations solved by genetic algorithms. To overcome the high computational cost associated with non-gradient heuristic optimization, this dissertation proposed a continuously relaxed gradient-based formulation for MTO. The proposed formulation was demonstrated with three manufacturing processes. For the sheet metal stamping process, by modeling stamping die cost manufacturing constraints and assuming resistant spot welding joints, the simultaneous optimization of base topology and component decomposition was, for the first time, attained using an efficient gradient-based optimization algorithm based on design sensitivities. For the composite manufacturing process, a cube-to-simplex projection and penalization method was proposed to handle the membership unity requirement. With the multi-component concept, a unique structural design solution for economical composite manufacturing was achieved. The component-wise anisotropic material orientation design for topology optimization was presented without prescribing a set of alternative discrete angles as required by most existing material orientation methods. For the additive manufacturing process, the MTO method enabled the design of additively manufactured structures larger than the printer's build volume. By modeling manufacturing constraints on the build volume limit and elimination of enclosed holes, the optimized structure was an assembly of multiple components, each produced by a powder bed additive manufacturing machine. The first reported 3D example of MTO was presented.PHDMechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/145989/1/yuqingz_1.pd