A Thousand Threads

‘Thread and fibre have always held me close. Words I may struggle with but any piece of cloth can speak to me. Thread lets me play and explore, it is a material that all people engage with. It is the clothes you wear and the sheets you sleep between. It ties things together. Threads are used in labelling, but words are given precedence. I wrestle with a label that was given me. I read about it, I explore what is said about it in many different ways in our world. It takes over my processes. I fight back, but I I fall into letting it define me again. I am hoping that you will share a label that has been applied to you or a friend. That you will hang a tag on the walls of this box to share that label. I am hoping to use these words in an exploratory activity that will continue. I am beginning to see through this process. A wheelchair is a standard icon for disability. It is usually interpreted as referring to disabilities that are present physically. I started making wheelchairs in my art practice because I do use one. It was a different way to explore the heavily laden subject of my otherness. The longer I have built wheelchairs of varying materials and sizes the more I have come to see my crafted wheelchairs as an exploration of a mind that is labelled 'mentally ill’. Myself, I cannot just push a label aside again

The Effects of Consuming Eggs on the Physical and Cognitive Development of Food-Insecure Haitian Children

Within Latin America and the Caribbean, severe food insecurity is highest in Haiti. Fifty-five percent of the population lives below the poverty line with approximately 50% of the population undernourished. Given the typical diet in the developing world is primarily plant-based, the two studies presented in this thesis examine how eggs, a locally available animal protein, impact physical growth, cognitive development, and motor skills of food-insecure children from a single orphanage in Leogane, Haiti when added to the diet. In the first study, growth parameters in children ages 3-8 years old were measured at baseline, six months, and one year. At the study mid-point, two eggs, five days per week (10 eggs per week) were supplemented weekly for six months. Dietary diversity and nutrient intakes were assessed throughout the study using a 24-hour recall. Growth parameters were evaluated using anthropometric data including: height, weight, mid-upper arm circumference, and tricep skinfold thickness, while body mass index was calculated. Significant differences in anthropometric outcomes showed a decrease in growth velocity after egg introduction. Key findings from the study included poor growth velocity over the course of the study, likely due to insufficient energy needs. In addition, an increase in dietary diversity was found but not reflective of increased caloric intake. These outcomes support the known relationship between child undernutrition and food insecurity. In the second study, cognitive development and motor skills in children ages 3-6 years old were evaluated three times over the course of a year. At the study mid-point, two eggs, five days per week (10 eggs per week) were supplemented weekly for six months. Dietary diversity and nutrient intake was assessed using a 24-hour recall. Cognition and motor skill assessments were conducted using Early Screening Profiles with no significant differences in outcomes found between the control period and the egg intervention period. Key learnings from the study included insight into cognitive and motor skills for this group of food-insecure children, estimated nutrient intakes among children in this single orphanage, and estimated nutrient intakes from the egg intervention, along with knowledge of research challenges in a food insecure developing country

The Glasgow outcome at discharge scale: an inpatient assessment of disability after brain injury

This study assesses the validity and reliability of the Glasgow Outcome at Discharge Scale (GODS), which is a tool that is designed to assess disability after brain injury in an inpatient setting. It is derived from the Glasgow Outcome Scale-Extended (GOS-E), which assesses disability in the community after brain injury. Inter-rater reliability on the GODS is high (quadratic-weighted kappa 0.982; 95% confidence interval [CI] 0.968, 0.996) as is concurrent validity with the Disability Rating Scale (DRS) (Spearman correlation −0.728; 95% CI −0.819, −0.601). The GODS is significantly associated with physical and fatigue subscales of the short form (SF)-36 in hospital. In terms of predictive validity the GODS is highly associated with the GOS-E after discharge (Spearman correlation 0.512; 95% CI 0.281, 0.687), with the DRS, and with physical, fatigue, and social subscales of the SF-36. The GODS is recommended as an assessment tool for disability after brain injury pre-discharge and can be used in conjunction with the GOS-E to monitor disability between hospital and the community

LAVA Subsystem Integration and Testing for the RESOLVE Payload of the Resource Prospector Mission: Mass Spectrometers and Gas Chromatography

The Regolith and Environment Science & Oxygen and Lunar Volatile Extraction (RESOLVE) payload is part of Resource Prospector (RP) along with a rover and a lander that are expected to launch in 2020. RP will identify volatile elements that may be combined and collected to be used for fuel, air, and water in order to enable deeper space exploration. The Resource Prospector mission is a key part of In-Situ Resource Utilization (ISRU). The demand for this method of utilizing resources at the site of exploration is increasing due to the cost of resupply missions and deep space exploration goals. The RESOLVE payload includes the Lunar Advanced Volatile Analysis (LAVA) subsystem. The main instrument used to identify the volatiles evolved from the lunar regolith is the Gas Chromatograph-Mass Spectrometer (GC-MS). LAVA analyzes the volatiles emitted from the Oxygen and Volatile Extraction Node (OVEN) Subsystem. The objective of OVEN is to obtain, weigh, heat and transfer evolved gases to LAVA through the connection between the two subsystems called the LOVEN line. This paper highlights the work completed during a ten week internship that involved the integration, testing, data analysis, and procedure documentation of two candidate mass spectrometers for the LAVA subsystem in order to aid in determining which model to use for flight. Additionally, the examination of data from the integrated Resource Prospector '15 (RP' 15) field test will be presented in order to characterize the amount of water detected from water doped regolith samples

The James Webb Space Telescope: Contamination Control and Materials

The James Webb Space Telescope (JWST), expected to launch in 2018 or early 2019, will be the premier observatory for astronomers worldwide. It is optimized for infrared wavelengths and observation from up to 1 million miles from Earth. JWST includes an Integrated Science Instrument Module (ISIM) containing the four main instruments used to observe deep space: Near-Infrared Camera (NIRCam), Near-Infrared Spectrograph (NIRSpec), Mid-Infrared Instrument (MIRI), and Fine Guidance Sensor/Near InfraRed Imager and Slitless Spectrograph (FGS/NIRISS). JWST is extremely sensitive to contamination directly resulting in degradation in performance of the telescope. Contamination control has been an essential focus of this mission since the beginning of this observatory. A particular challenge has been contamination challenges in vacuum chamber operations

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information

Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: a before and after study.

The study aimed to test the hypothesis that hospital electronic prescribing and medicine administration (HEPMA) system implementation impacted patient discharge letter quality, and the nature and frequency of prescribing errors. A quasi experimental before and after retrospective case note review was conducted in one United Kingdom district general hospital. The total sample size was 318 (random samples of 159 before and after implementation), calculated to achieve a 10% error reduction with a power of 80% and p < 0.05. Adult patients discharged after ≥24 hour inpatient stay were assessed for discharge information documentation quality using a modified validated discharge document template. Prescribing errors were classified as medicine omissions, commissions, incorrect dose/frequency/ duration, drug interactions, therapeutic duplications or missing/inaccurate allergy information. Post-implementation assessments were undertaken four months after HEPMA implementation. Error severity was determined by a multidisciplinary panel consensus using the Medications at Transitions and Clinical Handoffs (MATCH) study validated scoring system. There were no statistically significant differences in patient demographics between the pre and post-implementation groups. Discharge information documentation quality improved; allergy documentation increased from 11 to 159/159 (p < 0.0001). The number of patients with prescribing errors reduced significantly from 158 to 37/159 (p < 0.001).Prescribing error category incidence identified in preimplementation patients was reduced (e.g. omission incidence from 66 to 18/159 (p < 0.001)), although a new error type (sociotechnical [errors caused by the system]) was identified post-implementation (n=8 patients). Post-implementation prescribing errors severity rating identified 8/37 as likely to cause potential patient harm. In conclusion, HEPMA implementation was associated with improved discharge documentation quality, statistically significant prescribing error reduction and prescribing error type alteration. There remains a need to be alert for potential prescribing errors

Hospital discharge information communication and prescribing errors: a narrative literature overview.

Objectives - To provide a narrative overview of the literature on discharge information communication and medicines discharge prescribing error rate in the UK and other similar healthcare systems. Methods - A narrative review of the peer reviewed literature (2000-2014) on communication of discharge information from hospitals to general practitioners. Databases included were MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, and International Pharmacy Abstracts database. Results - The search yielded 673 results with 15 papers satisfying all inclusion criteria. Direct comparison of studies was not feasible due to differences in study populations and outcome measures. No studies reported post Hospital Electronic Prescribing and Medicine Administration (HEPMA) implementation. Studies (n=6) investigating handwritten discharge communication systems demonstrated medicine information inaccuracy ranging from 0.81 errors per patient to 17.5% medicines with errors and 67% letters missing medicines change information; with 77% assessed as legible. Studies (n=4) comparing interim electronic solutions with traditional showed variable results: improved, unchanged or decreased medicine information accuracy. Studies researching solely interim electronic solutions (n=5) with one including prescribing error rate assessment at 8.4% of prescribed items and identification of a new electronic system-related error type. Conclusion - Implementation of interim electronic discharge solutions resulted in complete legibility but did not eradicate information and prescribing errors. A paucity of information is available about HEPMA implementation impact on discharge information communication and prescribing error rates. There is urgent need for formal evaluation in this area