Implementation of Physician Orders for Life Sustaining Treatment in nursing homes in California: evaluation of a novel statewide dissemination mechanism.

BackgroundImplementing Physician Orders for Life Sustaining Treatment (POLST) forms aims to improve communication of life-sustaining treatment preferences across care venues. California enabled this clinical tool in 2009, and a novel intervention of community coalitions was undertaken to advance POLST in localities around the state. Coalitions engaged facilities, including nursing homes (NHs), to foster POLST adoption. Eighteen months after introduction of POLST, we studied POLST implementation in California NHs.MethodsNHs randomly selected in coalition and non-coalition areas were mailed surveys about POLST preparation and use in 2010. Coalitions identified which NHs they worked with.ResultsOf 546 NHs surveyed, 143 (52 %) in coalition areas and 141 (52 %) in non-coalition areas responded. In 82 % of responding NHs, staff received POLST education and 59 % of NHs reported having a formal policy on handling POLST. Two-thirds of NHs had admitted a resident with a POLST, and 15 % of newly admitted residents over the past month had a POLST (range 0-100 %). Eighty-one percent of NHs had completed a POLST with a resident. Fifty-four percent of residents were estimated to have a POLST (range 0-100 %) (coalition area NHs 60 % vs. non- coalition area NHs 48 %, p = 0.02). Within coalition areas, NHs that had worked with coalitions were more likely to have completed a POLST with a resident after admission than NHs that had not worked with coalitions. Few NHs (7 %) reported difficulty following POLST orders, but 38 % noted difficulty involving physicians in POLST completion.ConclusionLess than 2 years after introduction, many California nursing homes report using POLST, although some NHs reported no experience. A novel community coalition intervention facilitated POLST implementation

Investigating Hydrologic Alteration as a Mechanism of Fish Assemblage Shifts in Urbanizing Streams

Stream biota in urban and suburban settings are thought to be impaired by altered hydrology; however, it is unknown what aspects of the hydrograph alter fish assemblage structure and which fishes are most vulnerable to hydrologic alterations in small streams. We quantified hydrologic variables and fish assemblages in 30 small streams and their subcatchments (area 8-20 km 2) in the Etowah River Catchment (Georgia, USA). We stratified streams and their subcatchments into 3 landcover categories based on imperviousness (20% of subcatchment), and then estimated the degree of hydrologic alteration based on synoptic measurements of baseflow yield. We derived hydrologic variables from stage gauges at each study site for 1 y (January 2003-2004). Increased imperviousness was positively correlated with the frequency of storm events and rates of the rising and falling limb of the hydrograph (i.e, storm flashiness ) during most seasons. Increased duration of low flows associated with imperviousness only occurred during the autumn low-flow period, and this measure corresponded with increased richness of lentic tolerant species. Altered storm flows in summer and autumn were related to decreased richness of endemic, cosmopolitan, and sensitive fish species, and decreased abundance of lentic tolerant species. Species predicted to be sensitive to urbanization, based on specific life-history or habitat requirements, also were related to stormflow variables and % fine bed sediment in riffles. Overall, hydrologic variables explained 22 to 66% of the variation in fish assemblage richness and abundance Linkages between hydrologic alteration and fish assemblages were potentially complicated by contrasting effects of elevated flows on sediment delivery and scour, and mediating effects of high stream gradient on sediment delivery from elevated flows. However, stormwater management practices promoting natural hydrologic regimes are likely to reduce the impacts of catchment imperviousness on stream fish assemblages. ?? 2005 by The North American Benthological Societ

Learning to become an online editor: the editathon as a learning environment

This study explores Wikipedia as a site for learning. In particular it traces how people learn to become Wikipedia editors through engagement in an editathon, a training event for people who want to become a volunteer editor. The study is original in its emphasis on the various types of knowledge editors acquire as they develop expertise. Determining the knowledge needed to contribute to Wikipedia is significant in terms of understanding Wikipedia as a site for learning. Data was gathered from nine participants who took part in an ‘editathon’ event on the theme of the Edinburgh Seven. The study used a rigorous methodology, combining quantitative social network analysis, documenting the online activity of participants as they created and edited Wikipedia pages, with qualitative interviews, which recorded participants reflections on their participation in the editathon. A key finding is that conceptual and procedural knowledge are representative of the foundational knowledge needed to contribute to Wikipedia actively as an editor. However, this knowledge on its own is not sufficient. Editors also develop socio-cultural and relational knowledge forms of knowledge to enable them to operate and problem-solve effectively. The relationship between the physical and the digital is important, since socio-cultural and relational knowledge are developed through active experimentation as the editathon engage with physical objects to create the online wiki pages

Assessing Communities of Practice in health policy : A conceptual framework as a first step towards empirical research

Peer reviewe

The 'Iron Cage' strengthened? Discretion and digital discipline

Research on changes in public administration associated with the adoption and use of information and communication technologies ('informatization'), almost univocally supports the conclusion that shop floor discretion disappears under their influence. We, however, are ill at ease with this direction in thought about discretion. Our unease is based on the scholarly work about practices, organizational learning and responsiveness. In this article, we test the thesis on the relation between informatization and operational discretion in an empirical research of operational discretion and informatization in two Dutch public agencies, both large and both automated. Our findings show that informatization does not destroy operational discretion, but rather obscures discretion. Based on the work of Argyris, we show that the phenomenon at work is 'participatory boundary practices', the direct personal ties that keep an organization together. ICTs destroy such links and thereby affect organizational learning. © Blackwell Publishing Ltd. 2007

Community-powered urban stream restoration: A vision for sustainable and resilient urban ecosystems

Urban streams can provide amenities to people living in cities, but those benefits are reduced when streams become degraded, potentially even causing harm (disease, toxic compounds, etc.). Governments and institutions invest resources to improve the values and services provided by urban streams; however, the conception, development, and implementation of such projects may not include meaningful involvement of community members and other stakeholders. Consequently, project objectives may be misaligned with community desires and needs, and projects may fail to achieve their goals. In February 2020, the 5(th) Symposium on Urbanization and Stream Ecology, an interdisciplinary meeting held every 3 to 5 y, met in Austin, Texas, USA, to explore new approaches to urban stream projects, including ways to maximize the full range of potential benefits by better integrating community members into project identification and decision making. The symposium included in-depth discussion about 4 nearby field case studies, participation of multidisciplinary urban stream experts from 5 continents, and input from the Austin community. Institutional barriers to community inclusion were identified and analyzed using real-world examples, both from the case studies and from the literature, which clarified disparities in power, equity, and values. Outcomes of the symposium have been aggregated into a vision that challenges the present institutional approach to urban stream management and a set of strategies to systematically address these barriers to improve restoration solutions. Integrating community members and other stakeholders throughout the urban restoration process, and a transparent decision-making process to resolve divergent objectives, can help identify appropriate goals for realizing both the ecological and social benefits of stream restoration

Measurement of the t t-bar production cross section in the dilepton channel in pp collisions at sqrt(s) = 7 TeV

The t t-bar production cross section (sigma[t t-bar]) is measured in proton-proton collisions at sqrt(s) = 7 TeV in data collected by the CMS experiment, corresponding to an integrated luminosity of 2.3 inverse femtobarns. The measurement is performed in events with two leptons (electrons or muons) in the final state, at least two jets identified as jets originating from b quarks, and the presence of an imbalance in transverse momentum. The measured value of sigma[t t-bar] for a top-quark mass of 172.5 GeV is 161.9 +/- 2.5 (stat.) +5.1/-5.0 (syst.) +/- 3.6(lumi.) pb, consistent with the prediction of the standard model.Comment: Replaced with published version. Included journal reference and DO

Search for anomalous t t-bar production in the highly-boosted all-hadronic final state

A search is presented for a massive particle, generically referred to as a Z', decaying into a t t-bar pair. The search focuses on Z' resonances that are sufficiently massive to produce highly Lorentz-boosted top quarks, which yield collimated decay products that are partially or fully merged into single jets. The analysis uses new methods to analyze jet substructure, providing suppression of the non-top multijet backgrounds. The analysis is based on a data sample of proton-proton collisions at a center-of-mass energy of 7 TeV, corresponding to an integrated luminosity of 5 inverse femtobarns. Upper limits in the range of 1 pb are set on the product of the production cross section and branching fraction for a topcolor Z' modeled for several widths, as well as for a Randall--Sundrum Kaluza--Klein gluon. In addition, the results constrain any enhancement in t t-bar production beyond expectations of the standard model for t t-bar invariant masses larger than 1 TeV.Comment: Submitted to the Journal of High Energy Physics; this version includes a minor typo correction that will be submitted as an erratu

Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

<p>Abstract</p> <p>Background</p> <p>The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).</p> <p>Methods</p> <p>The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.</p> <p>Results</p> <p>Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.</p> <p>Conclusion</p> <p>Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.</p