The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

Background: Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. Methods: During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. Result: Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. Conclusions: Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learnin

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

Objective To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. Data Sources/Study Setting Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. Study Design A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. Data Collection Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. Principal Findings The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. Conclusions Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls

From whole-organ imaging to in-silico blood flow modeling: a new multi-scale network analysis for revisiting tissue functional anatomy

We present a multi-disciplinary image-based blood flow perfusion modeling of a whole organ vascular network for analyzing both its structural and functional properties. We show how the use of Light-Sheet Fluorescence Microscopy (LSFM) permits whole-organ micro- vascular imaging, analysis and modelling. By using adapted image post-treatment workflow, we could segment, vectorize and reconstruct the entire micro-vascular network composed of 1.7 million vessels, from the tissue-scale, inside a * 25 × 5 × 1 = 125mm 3 volume of the mouse fat pad, hundreds of times larger than previous studies, down to the cellular scale at micron resolution, with the entire blood perfusion modeled. Adapted network analysis revealed the structural and functional organization of meso-scale tissue as strongly connected communities of vessels. These communities share a distinct heterogeneous core region and a more homogeneous peripheral region, consistently with known biological functions of fat tissue. Graph clustering analysis also revealed two distinct robust meso-scale typical sizes (from 10 to several hundred times the cellular size), revealing, for the first time, strongly connected functional vascular communities. These community networks support heterogeneous micro-environments. This work provides the proof of concept that in-silico all-tissue perfusion modeling can reveal new structural and functional exchanges between micro-regions in tissues, found from community clusters in the vascular graph

Recurrent, Robust and Scalable Patterns Underlie Human Approach and Avoidance

BACKGROUND. Approach and avoidance behavior provide a means for assessing the rewarding or aversive value of stimuli, and can be quantified by a keypress procedure whereby subjects work to increase (approach), decrease (avoid), or do nothing about time of exposure to a rewarding/aversive stimulus. To investigate whether approach/avoidance behavior might be governed by quantitative principles that meet engineering criteria for lawfulness and that encode known features of reward/aversion function, we evaluated whether keypress responses toward pictures with potential motivational value produced any regular patterns, such as a trade-off between approach and avoidance, or recurrent lawful patterns as observed with prospect theory. METHODOLOGY/PRINCIPAL FINDINGS. Three sets of experiments employed this task with beautiful face images, a standardized set of affective photographs, and pictures of food during controlled states of hunger and satiety. An iterative modeling approach to data identified multiple law-like patterns, based on variables grounded in the individual. These patterns were consistent across stimulus types, robust to noise, describable by a simple power law, and scalable between individuals and groups. Patterns included: (i) a preference trade-off counterbalancing approach and avoidance, (ii) a value function linking preference intensity to uncertainty about preference, and (iii) a saturation function linking preference intensity to its standard deviation, thereby setting limits to both. CONCLUSIONS/SIGNIFICANCE. These law-like patterns were compatible with critical features of prospect theory, the matching law, and alliesthesia. Furthermore, they appeared consistent with both mean-variance and expected utility approaches to the assessment of risk. Ordering of responses across categories of stimuli demonstrated three properties thought to be relevant for preference-based choice, suggesting these patterns might be grouped together as a relative preference theory. Since variables in these patterns have been associated with reward circuitry structure and function, they may provide a method for quantitative phenotyping of normative and pathological function (e.g., psychiatric illness).National Institute on Drug Abuse (14118, 026002, 026104, DABK39-03-0098, DABK39-03-C-0098); The MGH Phenotype Genotype Project in Addiction and Mood Disorder from the Office of National Drug Control Policy - Counterdrug Technology Assessment Center; MGH Department of Radiology; the National Center for Research Resources (P41RR14075); National Institute of Neurological Disorders and Stroke (34189, 05236

La compétence pédagogique dans la formation des personnels de bibliothèques universitaires : enjeux et réalités

L’évolution des modes d’accès à l’information, des publics étudiants et des manières d’apprendre au cours des dernières décennies a amené les professionnels des bibliothèques à se questionner sur l’intérêt, ou la nécessité, d’investir le champ de la formation des usagers, tant il est apparu que l’information literacy était un véritable enjeu de la réussite académique. La compétence pédagogique est ainsi devenue une nouvelle attente du milieu des bibliothèques universitaires.Cette compétence reste cependant peu travaillée dans la formation initiale en France. Elle constitue par contre un axe qui se développe dans l’offre de formation tout au long de la vie. Les principaux organismes de formation se sont ainsi associés pour élaborer un catalogue de modules articulés avec un référentiel de compétences du formateur et de la formatrice en bibliothèques universitaires. Un label national, expérimenté dans un premier temps dans plusieurs établissements de l’est de la France, permet à présent de valider ces acquis d’apprentissage.L’évolution de la formation des bibliothécaires-formateurs gagne ainsi en maturité, mais elle mérite d’être sans cesse réinterrogée au regard de l’évolution des besoins et des usages, ainsi que des transformations des identités professionnelles des personnels des bibliothèques.The evolution of the methods used to access information, student audiences and ways of learning over the last few decades has led library professionals to question the interest, or the necessity, of investing in the field of user training, as it has become clear that information literacy is a real stake in academic success. Pedagogical competence has thus become a new expectation of the university library community.However, this skill is still underdeveloped during initial training in France. On the other hand, it is an area that is developing in the offer of lifelong training. The main training organizations have thus joined forces to develop a catalog of modules articulated with a repository of skills for the trainer and the university library trainer. A national label, initially tested in several establishments in eastern France, now makes it possible to validate these learning outcomes

The Impacts of Soil Microbial Communities on Translocated Sagebrush (\u3cem\u3eArtemisia tridentata\u3c/em\u3e) Seedlings Vary Along Gradients of pH but Not Organic Matter

Climate factors are often the focus of local adaptation studies, but there are additional biotic and abiotic factors, including microbial communities and soil properties, that may generate selection in plant populations. pH and soil organic matter (SOM) are important influencers of microbial communities. We investigated the influence of pH and SOM on plant-microbe interactions and local adaptation of big sagebrush to microbial communities. Sagebrush seeds and autoclaved soils from 4 sites were reciprocally transplanted in a greenhouse experiment. Half of these soils were treated with intact soil inoculum to identify microbial impacts and how these effects varied when sagebrush plants were translocated into new soils. Soil samples were tested for pH and organic matter to identify the abiotic factors that may drive local adaptation. Soil microbial communities influence sagebrush seedling survival negatively in more acidic soils and have weak positive effects in more alkaline soils. Sagebrush seedlings showed signs of local adaptation to microbial communities that come from soils similar to their home pH. There were no clear effects of SOM on seedling survival or influence of microbial communities at this life-history stage. This work has implications for the translocation of sagebrush seeds in restoration projects across the Great Basin

Biodiversity management:a supply chain practice view

Abstract This paper addresses biodiversity management in supply chains. Biodiversity loss is one of the most critical environmental issues currently facing the planet, and yet, rather surprisingly, has received little attention by management scholars and researchers in supply chain management. This paper aims for greater theoretical and practical understanding of the issue by examining firms’ purchasing and supply chain management practices that specifically relate to managing biodiversity. This qualitative study involves interviews with representatives of six firms and other organizations in Finland and New Zealand. The research shows how these firms adopt or develop biodiversity management practices that reduce or eliminate negative biodiversity outcomes or even contribute to biodiversity restoration and regeneration. Using an inductive theory building approach and integrating insights from the supply chain practice view into theorizing, this paper develops a theoretical framework of practices adopted and developed by firms to manage biodiversity

Polymorphisme des gènes HLA et KIR et l’impact sur le devenir de la greffe et le choix du donneur non apparenté de cellules souche hématopoïétiques : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC)

International audienc

A new model for the emergence of blood capillary networks

International audienceWe propose a new model for the emergence of blood capillary networks. We assimilate the tissue and extra cellular matrix as a porous medium, using Darcy's law for describing both blood and intersticial fluid flows. Oxygen obeys a convection-diffusionreaction equation describing advection by the blood, diffusion and consumption by the tissue. Discrete agents named capillary elements and modelling groups of endothelial cells are created or deleted according to different rules involving the oxygen concentration gradient, the blood velocity, the sheer stress or the capillary element density. Once created, a capillary element locally enhances the hydraulic conductivity matrix, contributing to a local increase of the blood velocity and oxygen flow. No connectivity between the capillary elements is imposed. The coupling between blood, oxygen flow and capillary elements provides a positive feedback mechanism which triggers the emergence of a network of channels of high hydraulic conductivity which we identify as new blood capillaries. We provide two different, biologically relevant geometrical settings and numerically analyze the influence of each of the capillary creation mechanism in detail. All mechanisms seem to concur towards a harmonious network but the most important ones are those involving oxygen gradient and sheer stress. A detailed discussion of this model with respect to the literature and its potential future developments concludes the paper