Implementation of a Deconditioning Prevention Program: Getting Dressed Makes a Difference

Implementation of a Deconditioning Prevention Program: Getting Dressed Makes a Difference Seleem R. Choudhury MSN, MBA, RN, CEN, FAEN Purpose. Deconditioning by immobility or bed rest affects essential body systems and diminishes functional capacity. Individuals age 65 and older have more hospital stays than any other age group. they also account for one out of three hospital admissions costing healthcare over $330 Billion annually. Numerous studies demonstrate this age group often struggle to get back to normal level of activity. . Empowering patients to dress and wear their own clothes can prevent deconditioning. Benefits to hospitals include reduced cost through admissions, improved patient flow by reducing their length of stay (LOS) which can lead to timelier admissions for other patients. A longer LOS also raises the probability of a hospital-acquired condition (HAC), which is an undesirable situation or condition that affects a patient during a hospital stay. Finally, patients who get dressed may feel more satisfied with the care they receive. Methods. To prevent deconditioning through the development of promoting activity by getting patients dressed which reduces the risk of deconditioning as measured by three outcomes: 1) LOS, 2) HAC, 3)Patient Satisfaction. LOS and HAC data were collected from chart review. Patient satisfaction was evaluated by HCAHPS metrics. Results. Three months of data were analyzed and compared in 2016 and 2017. The data were also segregated into age groups to analyze any benefit to over 65-year-olds. The comparison did not demonstrate clear correlation that the deconditioning program impacted the LOS and Patient Satisfaction. LOS comparison (n-832) showed improvement in month three in ages 18-59 and over 75. The ages 55-74 showed no decrease in LOS however recalculating the data from median versus mean showed all age groups LOS did decrease. Patient Satisfaction metrics (n-207) showed no clear inference or consistent pattern that deconditioning program improved satisfaction. Scores stayed comparable to previous years, especially among 18-54 age group. The 75 plus age group did see a decline in scores. Hospital Acquired Complications (HAC) was not a reliable indicator with only one incident in a two-year period. Methodological flaws in unreliable data and insufficient ability to separate variables within the electronic health record confounded comparison. Finally, the multi-faceted nature of discharges limited all of the indicators’ validity. Conclusions. The importance of being active is universally understood, yet hospitals struggle to implement this action. Data of 1-year mortalities of over 65 support that hospitals need to do more to improve this outcome. A simple program of getting dressed everyday has the potential to reduce LOS and with further study, improve 1-year mortality. This study also showed that whilst patient satisfaction is not increased, it also does not significantly decrease therefore it’s possible to assume that our patients want hospital staff to be assertive with preventing Deconditioning Syndrome. Finally, whilst not supported in this study future work, could analyze staff’s perception of patient readiness for discharge alongside data gradually demonstrating a decrease of LOS of 75-year old

Convergent Analytic Solutions for Homoclinic Orbits in Reversible and Non-reversible Systems

In this paper, convergent, multi-infinite, series solutions are derived for the homoclinic orbits of a canonical fourth-order ODE system, in both reversible and non-reversible cases. This ODE includes traveling-wave reductions of many important nonlinear PDEs or PDE systems, for which these analytical solutions would correspond to regular or localized pulses of the PDE. As such, the homoclinic solutions derived here are clearly topical, and they are shown to match closely to earlier results obtained by homoclinic numerical shooting. In addition, the results for the non-reversible case go beyond those that have been typically considered in analyses conducted within bifurcation-theoretic settings. We also comment on generalizing the treatment here to parameter regimes where solutions homoclinic to exponentially small periodic orbits are known to exist, as well as another possible extension placing the solutions derived here within the framework of a comprehensive categorization of ALL possible traveling-wave solutions, both smooth and non-smooth, for our governing ODE.Comment: arXiv admin note: text overlap with arXiv:math-ph/060606

Evolution of X-ray spectra of Cygnus X-3 with radio flares

Cygnus X-3, among the X-ray binaries, is one of the brightest in the radio band, repeatedly exhibiting huge radio flares. The X-ray spectra shows two definite states, low (correspondingly hard) and high (correspondingly soft). During the hard state the X-ray spectra shows a pivoting behaviour correlated to the radio emission. In the high state the X-ray spectra shows a gamut of behaviour which controls the radio flaring activity of the source. The complete evolution of the X-ray spectra along with the radio flaring activity is reported here, for the first time for this source.Comment: Bibliography has been correctly adde

Post-Double Hopf Bifurcation Dynamics and Adaptive Synchronization of a Hyperchaotic System

In this paper a four-dimensional hyperchaotic system with only one equilibrium is considered and its double Hopf bifurcations are investigated. The general post-bifurcation and stability analysis are carried out using the normal form of the system obtained via the method of multiple scales. The dynamics of the orbits predicted through the normal form comprises possible regimes of periodic solutions, two-period tori, and three-period tori in parameter space. Moreover, we show how the hyperchaotic synchronization of this system can be realized via an adaptive control scheme. Numerical simulations are included to show the effectiveness of the designed control

Detection of anti-correlated hard X-ray time lag in Cygnus X-3

The wide-band X-ray spectra of the high mass X-ray binary Cygnus X-3 exhibits a pivoting behavior in the `low' (as well as `hard') state, correlated to the radio emission. The time scale of the soft and hard X-rays' anti-correlation, which gave rise to the pivoting feature, was found to be less than a day from the monitoring observations by RXTE--ASM and CGRO--BATSE. In this Letter we report the detection of a lag of $\lesssim$ 1000s in the anti-correlation of the hard X-ray emission (20--50 keV) to that of the soft X-ray emission (2--7 keV), which may be attributed to the viscous time scale of flow of matter in the accretion disk. This suggests the geometrical picture of a truncated accretion disc with a Compton cloud inside the disc, the relative sizes of which determine the spectral shape. Any change in the disc structure will take place in a viscous time scale, with corresponding anti-correlated change in the Compton cloud. We also report the pivoting in the spectra in one span of a pointed observation when an episode of the rearranging of the accretion system is serendipitously observed. This is the first such observation of hard X-ray delay seen in the persistent Galactic microquasars, within the precincts of the hard state.Comment: Accepted in The Astrophysical Journal (Letters): in pres

Phase-field modeling of equilibrium precipitate shapes under the influence of coherency stresses

Coherency misfit stresses and their related anisotropies are known to influence the equilibrium shapes of precipitates. Additionally, mechanical properties of the alloys are also dependent on the shapes of the precipitates. Therefore, in order to investigate the mechanical response of a material which undergoes precipitation during heat treatment, it is important to derive the range of precipitate shapes that evolve. In this regard, several studies have been conducted in the past using sharp interface approaches where the influence of elastic energy anisotropy on the precipitate shapes has been investigated. In this paper, we propose a diffuse interface approach which allows us to minimize grid-anisotropy related issues applicable in sharp-interface methods. In this context, we introduce a novel phase-field method where we minimize the functional consisting of the elastic and surface energy contributions while preserving the precipitate volume. Using this method we reproduce the shape-bifurcation diagrams for the cases of pure dilatational misfit that have been studied previously using sharp interface methods and then extend them to include interfacial energy anisotropy with different anisotropy strengths which has not been a part of previous sharp-interface models. While we restrict ourselves to cubic anisotropies in both elastic and interfacial energies in this study, the model is generic enough to handle any combination of anisotropies in both the bulk and interfacial terms. Further, we have examined the influence of asymmetry in dilatational misfit strains along with interfacial energy anisotropy on precipitate morphologies

Investigating Neutron Polarizabilities through Compton Scattering on 3^3He

We examine manifestations of neutron electromagnetic polarizabilities in coherent Compton scattering from the Helium-3 nucleus. We calculate $\gamma ^3$He elastic scattering observables using chiral perturbation theory to next-to-leading order (${\mathcal O}(e^2 Q)$). We find that the unpolarized differential cross section can be used to measure neutron electric and magnetic polarizabilities, while two double-polarization observables are sensitive to different linear combinations of the four neutron spin polarizabilities. [Note added in 2018] An erratum for this paper has been posted as arXiv:1804.01206. Overall conclusions are unchanged, but quantitative results are affected appreciably.Comment: 4 pages, 4 figures; version published in Phys. Rev. Let

Iterative methods for elliptic finite element equations on general meshes

Iterative methods for arbitrary mesh discretizations of elliptic partial differential equations are surveyed. The methods discussed are preconditioned conjugate gradients, algebraic multigrid, deflated conjugate gradients, an element-by-element techniques, and domain decomposition. Computational results are included