Improving Completion Rate of Identifying Seniors At Risk (ISAR) Screening Tool in Emergency Department (ED) Setting

Background: Patients age 65 and older are identified as being an at-risk population for readmissions to the hospital within 30 days. Evidence based practice has shown that completing the Identifying Seniors At Risk (ISAR) screening tool can help to identify the needs of these patients so they can age in place at home with the proper resources. The screening tool consists of 6 questions. A score of 3 or more on the ISAR is deemed high-risk and a consult with case management should be considered. The average completion rate in an emergency department was identified as being 33%. The goal of this project was to increase nurses completing the ISAR screening tool to 80% in the emergency department for these patients. Methods: An in-service education on what the ISAR screening tool is and the importance of completing the screening tool to improve patient outcomes was done. Data was collected for three months prior to the in-service and data was collected for two months post in-service. The data included the average completion rate of the screening tool. Education was provided to all new employees during that time period, or those that returned to work after an extended period of time. Results: For three months (August – October) it was identified that the average completion rate of the ISAR screening tool was 33%. An in-service was provided to staff during the last 2 weeks of October. The two months post in-service (November – December), the average completion rate increased to 45%. Conclusions: Although positive results were shown in the data collected, barriers related to the pandemic limited this project to reaching its goal. Given that there was an increase in completion rates, it is recommended that additional data be collected when barriers related to pandemic subside. Once the completion rate is maintained, this project can be continued by tracking the number of readmissions post intervention. Implications for Clinical Practice: Improves patient outcomes and allows for hospital to advocate for this high-risk population to age in place at home. The goal of completing ISAR is to reduce preventable hospital readmissions within 30 days of discharge. By decreasing preventable hospital readmissions it can decrease penalties which allow the opportunity for the hospital to provide more resources for high-risk patients

Impact on Grant Fraud within the Government

My proposal and area of concentration will focus on the forensic accountant’s role in grant fraud. This role is more important now than ever, as fraudsters’ efforts have become more sophisticated over time. Grant fraud is particularly susceptible because more and more fraudsters are working within the company and understand the internal workings of the organization. Ensuring that grant notice of award regulations and rules are followed – and that relevant agencies and individuals follow all protocols under the budgeted term – are crucial components to ensuring the grant’s success. Within my research paper, I will cover all areas associated with grant fraud and link them to the topics covered during my time in the MS program. Such topics include fraud detection of grant misuse; investigation planning; obtaining evidence; information from witnesses and possible suspects; obtaining expert witnesses; preparing pertinent reports for law enforcement and lawyers; internal controls; and most importantly, the importance of ongoing monitoring of the grant and the funds administered to the grantee. The research provided throughout this project aims to provide insight into grant fraud; how it can negatively affect a company’s image, profit, and growth; and proving that there is an integral need for forensic accounting in order to provide company stabilization and prevention of loss

CGRP family of G protein-coupled receptors and their signalling in human cardiovascular cells

The aim of this body of work has been to further understanding of the signalling and functional properties of a unique family of cell surface receptors known as G protein-coupled receptors (GPCRs), and one of their subclasses: The CGRP receptor family. These receptors are crucial for transducing information from the extracellular to intracellular space. While much pharmacological research has gone into understanding the signalling and function of GPCRs in recombinant systems, there is a very little knowledge of these receptors in their native environment and at endogenous expression levels. Nor is there direct evidence for potentially controversial phenomena such as signalling bias in endogenous cells. This provided the impetus to address the need for a better understanding of the pharmacology of endogenous human calcitonin receptor-like receptor (CLR) in its native cellular environment. Therefore, primary human cardiovascular cells, gene editing techniques, and a host of intracellular assays were used to study the signalling properties of this GPCR family, revolving around the CLR, to attempt to uncover how these receptors function endogenously. Through the research presented here, it is shown that the CLR, when stimulated by endogenous agonists activates a whole host of signalling pathways to bring about differing physiological effects. In doing so it has revealed unique roles for calcitonin-gene related peptide (CGRP), adrenomedullin (AM), and the little-understood peptide adrenomedullin 2 (AM2). All of which are dependent on the presence of a group of GPCR accessory proteins known as receptor activity-modifying proteins (RAMPs). These proteins are not only crucial for CLR function, but this dissertation demonstrates the remarkable way in which they govern and dictate the intracellular signalling of the CGRP family of peptides endogenously. Beyond this, the G protein and accessory protein involvement in certain signalling cascades, the spatiotemporal aspects to CGRP peptide signalling, and the functional outcomes of signalling in cell organoid models are all explored. It is the author’s belief that this work adds a great deal to the understanding of the CLR, and more generally takes a step forward in the understanding of endogenous GPCR signalling bias

Play That Funky Music: A Study of Bacterial Contamination of Wind Instruments

Should there be standards to routinely clean instruments and what methods are available for that? It has been found that the bacteria and other microorganisms inside of musical instruments may be the culprit of respiratory infections in musicians (King et al. 2016). This project was divided into two experiments. First, clarinet reeds were introduced to three different species of bacteria. Then mouthpieces of trombonists and clarinetists of Eastern Kentucky University were swabbed and analyzed using a Colony Forming Unit assay. Bacteria was found to live on unused reeds for up to 30 days. Mouthpieces house millions of bacteria, determined by CFU assays. More evidence is needed to support the claim that differing methods of cleaning aid in bacteria removal. Standardization of instrument disinfection needs to be explored to improve the health of instruments and individuals

An analysis of a middle school curriculum: through the lens of personal responsibility, social responsibility, and social justice

One of the fundamental goals of 21st century schools is for students to become independent thinkers through the use of comprehensive academic curriculum that merges academic and social skills to prepare students to compete and engage in an increasingly changing world. The purpose of this qualitative study was to identify the ways in which three of Schwab’s four functions, social responsibility, personal responsibility, and social justice, were embedded and measured within core academic curriculum. The study also examined how teachers perceived students’ behaviors as a result of a social justice mindset. The study was conducted using a traditional qualitative methodology consisting of an in-depth review of district policy, curriculum, learning standards, and interviews with 8th grade core academic content teachers and the district curriculum specialist over a period of 8 months. The review of the data and interviews showed that there is a greater need to more purposefully embed social learning components within academic content. Changes in policy, practice, and research are necessary to achieve environments that equally prioritize academic and social learning

Gaussian Amicable Pairs

Amicable pairs are two integers where the sum of the proper divisors of one is the other and vice versa. Since the Gaussian integers have many of the properties of the regular integers, we sought to discover whether there exist any pairs of Gaussian integers with the same property. It turns out that they do exist. In fact, some of the normal amicable pairs carry over as Gaussian amicable pairs. Also discovered are pairs that have a complex part

Biarticular Muscles Influence Postural Responses: Implications for Treatment of Stiff-Knee Gait

Stiff knee gait is a prevalent and troublesome movement disorder among children with cerebral palsy, where peak knee flexion is diminished during swing phase. Rectus femoris transfer surgery, a common treatment for stiff-knee gait, reattaches the distal tendon of this biarticular, or two joint, muscle to a new site, such as the sartorius insertion on the tibia. Biarticular muscles play a unique role in motor control. As a biarticular muscle, rectus femoris may offer unrecognized benefits to maintain balance. This study uses musculoskeletal modeling and simulation to investigate the role of this biarticular muscle on balance recovery following support-surface translations. The hypothesis is that a preoperative simulation has increased balance recovery compared with two postoperative cases, and that a unilateral transfer simulation has improved balance recovery relative to a bilateral transfer. The influence of rectus femoris transfer surgery on balance recovery was assessed with forward dynamic simulations of a patient with cerebral palsy. A 3-dimensional musculoskeletal model was scaled to represent the size of the patient using previously collected gait analysis data. This pre-surgical model was altered to represent unilateral and bilateral rectus femoris tendon transfers to the sartorius. The mechanism used to maintain balance was based on a muscle stretch-reflex control model, where reflex properties were found using optimization. Each 6s simulation included 0.25s of quiet standing, 0.35s of support-surface translation (6 cm in the anterior and posterior directions, with a peak velocity of 23 cm/s), and 5.4s of balance recovery. Balance recovery was evaluated by recording whole-body center of mass displacements relative to the support surface. The preoperative simulations of balance recovery following support-surface translations maintained balance while both postoperative simulations did not. Moreover, the unilateral simulation maintained balance longer than the bilateral case in both support-surface translation directions. These findings support the hypothesis that the preoperative simulation has the best balance recovery, followed by the unilateral rectus femoris tendon transfer, and finally the bilateral transfer. This study’s results suggest that rectus femoris tendon transfer reduces balance recovery compared with the preoperative case, illustrating the biomechanical advantage that biarticular muscles have in motor control

Structural and dynamical analysis of ionic liquids in electric fields

Molecular rotors and molecular dynamics simulations are used to study changes in the structure and dynamics of ionic liquids in the presence of external electric fields. The immediate environment around the rotors is elucidated in the absence of the electric field from a study of the behaviour of the dyes in various ionic liquids. Using this knowledge, the effect of an electrode upon an ionic liquid at various depths was investigated by studying the change in the rotor properties upon application of a potential. This showed remarkable effects of an electrode upon the rotor properties up to 50 micrometres away from the electrode which persisted for over one hour. To attempt to rationalise these results, molecular dynamics simulations were performed on two ionic liquids in electric fields, and their structure and dynamics were studied over a range of electric fields. Particular focus was put onto the charge arm concept, as a replacement for the dipole in an ion. This was able to rationalise changes in the structure of the ion that were difficult to explain otherwise, such as changes to the conformation and rotation of the ions.Open Acces

The role of hypothalamus-pituitary-adrenal (HPA)-like axis in inflammatory pilosebaceous disorders

Skin is the largest peripheral endocrine organ and functions as a hormone target and endocrine gland. A cutaneous hypothalamus-pituitary-adrenal (HPA)-like axis enables the skin to respond to stress and regulates its steroidogenic activity. The pilosebaceous unit is a site for production and metabolism of a number of steroid hormones, including stress and sex hormones. This is an overview of the important role that the cutaneous HPA-like-axis plays in the pathogenesis and treatment of inflammatory pilosebaceous disorders, including acne, rosacea, seborrheic dermatitis, and hidradenitis suppurativa

The Relative Value of AER P&P Economic Education Papers

The CEE had been allocated one session in the AER Papers and Proceedings (P&P) since 1964. In 2008, the American Economic Association evaluated the allocation of AER Papers and Proceedings sessions to various AEA Committees. In response, the CEE was asked to prepare a one-page rationale for keeping that session. Their response (Committee on Economic Education, 2008) made several important defenses of the session, including that the quality of the papers published in these sessions must speak for itself. In this paper, we propose to evaluate the relative quality of AER P&P papers through citation analysis. Using the Social Science Citation Index, the citation counts of CEE AER P&P papers are compared to other papers included in the issue