Multicomponent approach to delirium prevention in the acute care setting: an evidence-based quality improvement project.

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development. Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of individuals with traumatic brain injuries. Purpose: The purpose of this quality improvement project was to improve patient outcomes (decrease fall rates, decrease restraint utilization, decrease length of stay) and increase nursing knowledge, implementation and documentation of the CAM tool. Procedures: Six ten-minute educational sessions on delirium and the use of the CAM tool were provided to nursing staff at an inpatient, long-term acute care facility in a suburban town. Retrospective chart audits were performed and the data collected included daily CAM charting compliance, CAM documentation upon admission, restraint usage, length of stay and falls rates for eight weeks prior to intervention compared to eight weeks post-intervention. Results: Thirty-four nurses participated in the delirium education intervention. There was a statistically significant improvement in daily CAM documentation (p=\u3c0.01) and patient length of stay (p=0.05). Improvements (though not significantly significant) in restraint utilization and CAM admission documentation were found. Patient demographic data (age, sex, admission diagnosis) from pre-intervention and post-intervention was collected to determine comparability between the samples, and the only statistically significant difference was in COVID admissions

Propulsion Working Group report

Existing technology limits and performances, high payoff technologies, propulsion technologies, electric propulsion systems, and advanced bipropellant systems are outlined

Searching for Effective Forces in Laboratory Insect Swarms

Collective animal behaviour is often modeled by systems of agents that interact via effective social forces, including short-range repulsion and long-range attraction. We search for evidence of such effective forces by studying laboratory swarms of the flying midge Chironomus riparius. Using multi-camera stereoimaging and particle-tracking techniques, we record three-dimensional trajectories for all the individuals in the swarm. Acceleration measurements show a clear short-range repulsion, which we confirm by considering the spatial statistics of the midges, but no conclusive long-range interactions. Measurements of the mean free path of the insects also suggest that individuals are on average very weakly coupled, but that they are also tightly bound to the swarm itself. Our results therefore suggest that some attractive interaction maintains cohesion of the swarms, but that this interaction is not as simple as an attraction to nearest neighbours

Major accounting problems in corporate affiliation

Thesis (M.B.A.)--Boston University This item was digitized by the Internet Archive

Dirty snow: The impact of urban particulates on a mid-latitude seasonal snowpack

This thesis examines the spatial distribution of particulate matter in snow around a mid-size, midlatitude city. Particulates are small, light absorbing impurities that are produced from the incomplete combustion of carbon-based fuel. When deposited on the snowpack, these particles reduce snow albedo and accelerate melt. Two experiments were designed to explore the distribution and effect of urban particulate emissions on snow surrounding Syracuse, NY (43.049897, -76.149102, pop: 149,000). The “directional study” examined the relationship between distribution and cross-city prevailing wind, while, the “transect study” examined the variability of particulate concentration with distance from a busy interstate highway. Fifteen sites were sampled over two winter seasons (2016-2017 and 2017-2018). Eight sites were located in the suburbs roughly aligned to the cardinal directions with respect to the city, one site was located within the city boundaries and six sites were located on a transect across I-90. Snow temperature, air temperature, wind speed/direction and albedo were recorded at each site. A snow core was collected for laboratory analysis using the Light Meter Filter Analysis method and two photos were taken of the snow surface for a second albedo analysis using ImageJ. At the city-scale, trend analyses show that particulate concentration decreases from W to E across the urban center and albedo increases from NW to SE. The small westerly shift between albedo and particulate trend analysis may be explained by a slight difference in measurement parameters. Albedo analysis measures the effect of particulates on the snow surface since the end of snow accumulation. Particulate concentration, however, measures the total quantity of particulates in the entire snowpack. Both analyses align with the WSW to NW prevailing wind that is responsible for the formation of lake effect snow from Lake Ontario and Lake Erie. That said, the observed distribution was found to be opposite expectations. This is likely a result of wind circulation patterns within the urban core. At the local-scale, high particulate concentration/low albedo was found adjacent to the interstate highway. Results show that the concentration does not necessarily decrease with distance from vehicle emissions. Instead, particulate distribution is altered by the presence of any obstacles within 600m of the highway. Snow surface photo analysis was able to determine the relative albedo of each site but not actual albedo value. Despite this, the photo analysis method looks promising for future citizen science based studies of particulate matter. Overall, findings suggest that urban particulate distribution in midlatitude snow is altered by city morphology and proximity to local emission sources. Future research is necessary to examine how this distribution affects climatic processes in the midlatitudes

Empowering Imagined Communities: Social Network Sites in a Chinese English as a Foreign Language Classroom

Little work has yet to explore the potential for the use of social network sites (SNSs) in the English as a Second Language/English as a Foreign Language (ESL/EFL) classroom, but recent trends in teaching English to speakers of other languages (TESOL) research suggest that SNSs may be a powerful context for language learning: offering students access to online communities of practice and /or imagined communities (as interpreted by Norton et al.); increased control of co-constructed/negotiated identities; and opportunities for empowering positions in authentic intercultural exchanges. This dissertation reports on a largely exploratory, empirical study of how the use of an American-based SNS in a Chinese EFLclass affected specific self-reported student attitudes toward motivation. Results showed that students using SNS showed a statistically significant increase in motivation orientation traditionally considered integrative with the most significant comparative gains being made by those measured to be more integrative at the outset of the study. Detailed survey results suggest that students were not just passive receivers or learners of language and culture, but they also saw the empowering possibility of taking up expert positions in this new context that they did not find in the -SNS classes. When considered together with recent motivation research, these results seem to create a picture of SNSs as an imagined international community: one in which cultural exchange is seen as going both ways