MOBILITY BOOST: A QUALITY IMPROVEMENT PROJECT TO BRIDGE A GAP IN CARE FOR HOSPITALIZED ADULTS

Early mobility quality improvement (QI) projects are leading the charge to shift the prevailing culture in acute care from a culture of immobility to a culture of mobility. Low mobility and hospital acquired functional decline is a persistent problem, especially for older adults, often leading to increased post acute care costs, increased risk of hospital readmission and increased mortality. Transition of care programs designed to improve care transitions and prevent hospital readmission exist but fail to include rehabilitation professionals or to adequately consider patient functional status during hospitalization. The goal of this research was to implement and evaluate an early mobility quality improvement (QI) project that added a physical therapist and mobility technician to an existing transition of care program (Project BOOST) to increase adult patients mobility and level of physical activity during hospitalization, using both quantitative and qualitative methods. The project was implemented from August 2, 2016 to February 4, 2017. A physical therapist rounded with one of two Project BOOST teams to promote increased patient mobility performed with a mobility technician daily. The physical therapist also recommended rehabilitation consultations (physical and occupational therapy) for appropriate patients. The AM-PAC “6 Clicks” Basic Mobility Short Form was used to set mobility tier levels for intervention group patients. Quantitative evaluation used observed hospital length of stay, 30 day same hospital all-cause readmission, and change in AM-PAC score from admission to discharge as outcome measures. Results showed that observed hospital length of stay decreased 0.9 days in the intervention group and 30 day same hospital all-cause readmission decreased 4.8%. Bivariate analysis of patient observed hospital length of stay was statistically significant for intervention group patients (p=0.07) but failed to reach statistical significance for same hospital readmission in intervention group patients (p=0.18). Qualitative evaluation used a phenomenological lens to explore the context of the early mobility quality improvement project and shared experience of patients and staff members exposed to more mobility and higher levels of activity during hospitalization. Twelve participants were interviewed during implementation of the project including four patients and eight staff members (physicians, nurses and a mobility technician). One overarching theme and four supporting themes were found from the data. The essential meaning was that mobility bridged a gap in care. Staff understood the benefits of early mobility for patients. Patients expressed how important mobility was for their discharge and quality of life. Patients with greater functional independence and higher mobility level reduced nursing burden of care. When patients were consistently presented with opportunities to be mobile and active during acute illness, they expected mobility to be a part of their daily care plan. This comprehensive evaluation of an early mobility quality improvement project found the intervention bridged a gap in care for patients. Adding a physical therapist to the Project BOOST team and promoting patient mobility during hospitalization resulted in improved patient outcomes. Early mobility quality improvement projects have the potential to transform clinical practice and improve quality of care

The UK children's publishing house: adapting to change for the multimedia market.

Reports the results of the first stage of research (in progress, 1997-2000), which aims to develop an understanding of the challenges facing publishers who have entered the children's multimedia market in the UK in the 1980s and 1990s. The findings of the first stage of the research amongst established UK publishers producing multimedia for children are described. These point to a number of factors that appear to be critical to the success of publishers in the multimedial market: modification of corporate culture, internal structures and processes; branding of the company's chosen multimedia identity; focusing on the added value element of multimedia products; promotion of organisational learning, innovation and creativity within the company; and sourcing necessary skills effectively. A second study will examine the perceptions of new media companies which have entered this market

Noninvasive quantification of drug delivery from an implantable MEMS device

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Chemical Engineering, February 2005.Includes bibliographical references.(cont.) sensors in vivo in real time and corroborated by scintillation of urine samples. The goal of monitoring drug delivery from an implant in vivo, in real time and without disturbing the tissue environment, was accomplished. The results described in this thesis suggest a number of future studies including feedback-controlled delivery of drugs and real-time monitoring and analysis of the effect of the immune response to foreign bodies on drug and analyte transport.The goal of this thesis was to develop a method for quantifying the rate of release of drugs from an implanted MEMS (micro electro mechanical systems) drug delivery device without disrupting the surrounding tissue. Most current methods for evaluating tissue response to implants and drug release are invasive and destructive. A method for measuring drug transport from implants in vivo, non-invasively and in real time, would have the potential to yield new information about the body's response to implants and the impact of the tissue response on drug and analyte transport. An impedance based sensor was designed to monitor the release of drug from the drug delivery MEMS device reservoirs. The sensor measures the change in conductivity of the contents of the reservoir as the drug dissolves, which is related to the drug release rate. A four element equivalent circuit was developed to describe the impedance spectrum of the reservoirs based on the physical components of the system. The solution resistance and double layer capacitance elements are functions of the amount of drug that has dissolved and were used to measure the drug release rate in real time. The sensors were tested by monitoring drug release in vitro in saline. Independent measurements of the radioactive tracer released from the well were in complete quantitative agreement with the release rates measured by the electrochemical sensors. A finite element transport model of the system also gave predicted release times in agreement with the sensor and radioactivity measurements of release times in stirred saline. MEMS devices with impedance sensors were implanted subcutaneously in rats and activated after 3-11 days post-implantation. Release of radiolabeled mannitol was monitored by theby Audrey M. Johnson.Ph.D

Targeting Hispanic Immigrants with Food Safety Communications

Hispanics are the largest minority population in the United States, according to the 2000 U.S. Census, and the fastest growing. If they are immigrants, they are often dealing with cultural issues as well as new technological applications and social systems. The need for education programs and dissemination of food safety information to this growing segment of the population is evident. This study sought to determine the group’s knowledge of food safety and its primary channels for receiving such information. A questionnaire was developed and translated into Spanish. Face-to-face data collection facilitated by a trusted community partner proved to be a successful means of collecting data from this audience, who are often difficult to reach and may be unwilling to speak with people associated with government. Specific areas of lack of knowledge emerged. The respondents struggled most with questions about proper handling of leftovers containing meat, accurate water temperature for washing and rinsing dishes, handling frozen foods, and defrosting meat. From the attitude questions, the authors found that the target group felt food safety was important, was more threatened in food service outlets than in the home, and was overemphasized. The channel used most frequently and trusted most was television

BOOSTing Patient Mobility and Function on a General Medical Unit by Enhancing Interprofessional Care

Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and between cross-sectional comparison groups one year prior were used for Difference in Difference analysis. Bivariate comparisons between the treatment and a cross-sectional comparison group from one year prior showed a statistically significant change in LOS Index. No other bivariate comparisons were statistically significant. Difference in Difference methods showed no statistically significant change in observed LOS, LOS Index, or 30-day readmission. Patients in the treatment group had statistically significant improvements in functional status and highest level of mobility achieved. Physical function and mobility improved for patients who participated in mobility sessions. Mobility technicians may contribute to improved care quality and patient safety in the hospital

APOGEE Kinematics I: Overview of the Kinematics of the Galactic Bulge as Mapped by APOGEE

We present the stellar kinematics across the Galactic bulge and into the disk at positive longitudes from the SDSS-III APOGEE spectroscopic survey of the Milky Way. APOGEE includes extensive coverage of the stellar populations of the bulge along the mid-plane and near-plane regions. From these data, we have produced kinematic maps of 10,000 stars across longitudes 0 deg < l < 65 deg, and primarily across latitudes of |b| < 5 deg in the bulge region. The APOGEE data reveal that the bulge is cylindrically rotating across all latitudes and is kinematically hottest at the very centre of the bulge, with the smallest gradients in both kinematic and chemical space inside the inner-most region (l,|b|) < (5,5) deg. The results from APOGEE show good agreement with data from other surveys at higher latitudes and a remarkable similarity to the rotation and dispersion maps of barred galaxies viewed edge on. The thin bar that is reported to be present in the inner disk within a narrow latitude range of |b| < 2 deg appears to have a corresponding signature in [Fe/H] and [alpha/Fe]. Stars with [Fe/H] > -0.5 have dispersion and rotation profiles that are similar to that of N-body models of boxy/peanut bulges. There is a smooth kinematic transition from the thin bar and boxy bulge (l,|b|) < (15,12) deg out into the disk for stars with [Fe/H] > -1.0, and the chemodynamics across (l,b) suggests the stars in the inner Galaxy with [Fe/H] > -1.0 have an origin in the disk.Comment: Accepted by ApJ 15 December 201

Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU

Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and for length of stay were found. The regression model determined that time to first physical therapy evaluation, Charlson Comorbidity Index score, mean days of physical therapy treatment and mechanical ventilation were associated with increased hospital length of stay. Time to first physical therapy evaluation in the intensive care unit and the hospital, and mean days of physical therapy treatment associated with hospital length of stay. Further prospective study is required to determine whether shortening time to physical therapy evaluation and treatment in a cardiothoracic intensive care unit could influence length of stay

Characterizing Biology Education Research: Perspectives from Practitioners and Scholars in the Field

Biology education research (BER) is a recently emerging field mainly focused on the learning and teaching of biology in postsecondary education. As BER continues to grow, exploring what goals, questions, and scholarship the field encompasses will provide an opportunity for the community to reflect on what new lines of inquiry could be pursued in the future. There have been top-down approaches at characterizing BER, such as aims and scope provided by professional societies or peer-reviewed journals, and literature analyses with evidence for current and historical research trends. However, there have not been previous attempts with a bottom-up approach at characterizing BER by directly surveying practitioners and scholars in the field. Here, we share survey results that asked participants at the Society for the Advancement of Biology Education Research (SABER) annual meeting what they perceive as current scholarship in BER as well as what areas of inquiry in the field that they would like to see pursued in the future. These survey responses provide us with information directly from BER practitioners and scholars, and we invite colleagues to reflect on how we can collectively and collaboratively continue to promote BER as a field

Connect to Protect® Researcher-Community Partnerships: Assessing Change in Successful Collaboration Factors over Time

Fifteen research sites within the Adolescent Medicine Trials Network for HIV/AIDS Interventions launched Connect to Protect community coalitions in urban areas across the United States and in Puerto Rico. Each coalition has the same overarching goal: Reducing local youth HIV rates by changing community structural elements such as programs, policies, and practices. These types of transformations can take significant amounts of time to achieve; thus, ongoing successful collaboration among coalition members is critical for success. As a first step toward building their coalitions, staff from each research site invited an initial group of community partners to take part in Connect to Protect activities. In this paper, we focus on these researcher-community partnerships and assess change in collaboration factors over the first year. Respondents completed the Wilder Collaboration Factors Inventory at five time points, approximately once every two to three months. Results across all fifteen coalitions show significant and positive shifts in ratings of process/structure (p&lt;.05). This suggests that during the first year they worked together, Connect to Protect researcher-community partners strengthened their group infrastructures and operating procedures. The findings shed light on how collaboration factors evolve during coalition formation and highlight the need for future research to examine change throughout subsequent coalition phases.&nbsp;(Peer Reviewed

Chemical abundance gradients from open clusters in the Milky Way disk: results from the APOGEE survey

Metallicity gradients provide strong constraints for understanding the chemical evolution of the Galaxy. We report on radial abundance gradients of Fe, Ni, Ca, Si, and Mg obtained from a sample of 304 red-giant members of 29 disk open clusters, mostly concentrated at galactocentric distances between ~8 - 15 kpc, but including two open clusters in the outer disk. The observations are from the APOGEE survey. The chemical abundances were derived automatically by the ASPCAP pipeline and these are part of the SDSS III Data Release 12. The gradients, obtained from least squares fits to the data, are relatively flat, with slopes ranging from -0.026 to -0.033 dex/kpc for the alpha-elements [O/H], [Ca/H], [Si/H] and [Mg/H] and -0.035 dex/kpc and -0.040 dex/kpc for [Fe/H] and [Ni/H], respectively. Our results are not at odds with the possibility that metallicity ([Fe/H]) gradients are steeper in the inner disk (R_GC ~7 - 12 kpc) and flatter towards the outer disk. The open cluster sample studied spans a significant range in age. When breaking the sample into age bins, there is some indication that the younger open cluster population in our sample (log age < 8.7) has a flatter metallicity gradient when compared with the gradients obtained from older open clusters.Comment: 4 pages, 3 figures, To appear in Astronomische Nachrichten, special issue "Reconstruction the Milky Way's History: Spectroscopic surveys, Asteroseismology and Chemo-dynamical models", Guest Editors C. Chiappini, J. Montalb\'an, and M. Steffen, AN 2016 (in press)