A social psychological study of ethnonyms: Cognitive representation of the ingroup and intergroup hostility

Ethnonyms (M. G. Levin & L. P. Potapov, 1964; from the Greek roots meaning "a national group" and "name") are the names an in-group uses to distinguish itself from out-groups. There has been no social psychological research to date exploring the effects of ethnonyms. The authors report the results of 3 studies examining the potential effects of various features of ethnonyms on intergroup behavior. Analyses of archival data indicate that among indigenous African cultures (Study 1), indigenous Native American cultures (Study 2), and African Americans (Study 3), intergroup hostility was greater among in-groups characterized by less complex ethnonyms. Discussion considers the implications of these results and suggests new directions for research in the social psychological study of ethnonyms

Perceived problem difficulty, perseverance, and success in the locus of control-affect relationship

A number of research efforts in various areas of psychology, have substantiated a relationship between perceived control of reinforcement and affective states. Specifically, the perception that such control is internal (as opposed to external) is associated with positive affect. In the present study, an investigation was conducted which attempted to delineate the process by which this relationship occurs. A causal model was hypothesized which consisted of the following four steps: (1) The perception of internal control is associated with less perceived problem difficulty. (2) Less perceived problem difficulty in turn elicits greater perseverance. (3) This greater perseverance produces greater success. (4) This greater success in turn causes a more positive change in affect. Using a specially designed computer program which involved attempts at solving mazes, support was found for each of the four steps in the model. Implications of these results are discussed

Torsional Rotordynamics Of Machinery Equipment Strings

Short CourseOne of the foremost concerns facing rotating equipment users today is that of torsional vibration. In contrast to lateral vibration, torsional vibration is rarely monitored. As a result, torsional failures can be especially heinous since the first symptom of a problem is often a broken shaft, gear tooth, or coupling. In the past, torsional vibration problems were considered to be rare; however the number of torsional field problems has markedly increased recently with the advent of higher power, higher complexity variable frequency drives (VFDs). The increased risk plus the difficulty of detecting incipient failures in the field makes the performance of a thorough torsional vibration analysis an essential component of the turbomachinery design process. There are three primary objectives to this Short Course. First, it will provide users with a basic understanding of steadystate torsional vibrations, their potential for generating problems, and methodologies that are commonly used to analyze and avoid these problems. This portion of the course is aimed at younger, less experienced users, although veteran users will probably also benefit from the review. Second, it will provide users with some understanding of the more complex issues related to transient torsional vibration and acceptance based on stress analysis. Third, it will educate users on how VFDs work, and why they are a concern from a torsional standpoint. This portion will be beneficial to all users since modern VFDs are not well understood, especially by mechanical engineers. The course will be based on practical examples starting from the simple to the complex with some material based on a tutorial the lead author presented at this very show in 1996, Practical Design Against Torsional Vibration. Among the topics that will be discussed include description of torsional vibration, modeling, undamped analysis, Campbell diagrams, excitations generated by various mechanical and electrical components, steady-state and transient analyses, synchronous motor startups, and fatigue life analysis. At the conclusion of this portion, the user should have a good grasp of the fundamentals of this topic. A significant portion of time will be spent on VFDs. Topics covered will include VFD types, excitation frequencies generated by various VFDs, typical excitation amplitudes, control loop instabilities that can lead to problems, coupled electro-mechanical analyses, and design procedures for preventing VFD-related torsional issues up-front. At the conclusion of this course, all users should have sufficient understanding of the relevant concepts so that they should be able to take the proper steps to prevent torsional vibration problems from occurring in their equipment, even when their system contains a VFD

Improving Orthopedic Surgeries Healthgrades Rating by Reducing Complications

Abstract: Lehigh Valley Health Network’s orthopedic surgery rating on Healthgrades, the online hospital rating site, is only one star for both hip and total knee replacements. This does not accurately reflect the healthcare services provided. Healthgrades calculates their ratings with clinical outcomes data obtained from Medicare, focusing on mortality and complication rates. An in depth analysis of complications obtained as a result of hip and total knee replacements indicated higher than average rates of acute renal failure, 584.9, and complications affecting other body systems, 997.**, most notably other respiratory problems, 997.39. The instances of acute renal failure are decreasing from 2010 to 2014 with a standardized change in the diagnosis related group. While the trend of all 997.** complications show a high spike in 2012 and 2013. These complications were miscoded by outside contractors and a screening and educating initiative has been put in place to stop the incorrect coding. Each year, orthopedic surgeries’ Healthgrades will improve as the instances of complications continue to decrease. Background: With many competing hospital facilities in the same area, patients now have options of where to obtain their healthcare. The customers turn to online ratings to aid in their choice of facility. Healthgrades is an independent online healthcare rating system that assesses patient safety, clinical quality, patient experience, readmission rates, and timely and effective care for hospitals, physicians, dentists, and nursing homes based exclusively on clinical outcomes. Potential customers can compare these rankings to determine which healthcare facility will provide the best care for their medical needs. Healthgrades uses a star based rating system with one star, indicating that a hospital or physician performed worse than expected in an area, to five stars, meaning they performed better than expected.1 In general, Lehigh Valley Health Network shows average to high rankings for its services, except for orthopedic surgeries, which only have a one star rating for both hip and total knee replacements.2 By improving the Networks orthopedic Healthgrade rating, it will attract more patients and increase the Networks competitive edge against the several other orthopedic specialty hospitals in the Lehigh Valley area. In order to improve the orthopedic rating, it is necessary to gain an understanding of how these ratings are determined. To define accurate ratings across diverse hospitals and physicians, Healthgrades obtains public data that is representative of the entire population from Medicare claims records. Healthgrades then looks at in-hospital complications and risk-adjusted mortality rates over a three year period using information from approximately 40 million patients discharges.1 Healthgrades estimates a predicted value for mortality and complications based on risk factors such as age, gender, current health condition, etc.3 Since Medicare waits two years before releasing this data for use, the 2014 rankings are determined by clinical outcomes from 2010 to 2012.1 Complications postoperatively, either a direct result of surgery or hospital stay, are common in joint replacement patients. The average complication rate following hip and total knee replacement surgeries was 3.4% nationwide in 2013, calculated from Medicare claims data.4 For all total joint replacements, serious complications occur in less than two percent of patients.5 An individual hospital’s complication rates can be skewed by many factors outside of the operating room. A study conducted at Northwestern University proved that a hospital with a respected reputation could have high complications rates that are not indicative of poor quality, but rather inconsistent record keeping.6 An in depth examination of hip and total knee replacement procedures will help to uncover the reasons behind orthopedic surgeries Healthgrades rating. Methodology: Healthgrades does not publicize their algorithm for determining their rankings, but the Medicare data they use is available to the public. To accurately determine the weakest area in orthopedics that greatly affects the rating, first, information was obtained from the Lehigh Valley Health Network databases on all cases from 2010 to 2014 that involved either a total knee replacement or a hip replacement. The patients’ age, gender, diagnosis, procedure, diagnosis related group (DRG), and complications, either present on admission or obtained during their hospital stay, were included for each patient analyzed. There were 3011 total knee replacement patients and 1883 hip replacement patients. Only patients who underwent elective surgeries and did not have a preexisting fracture were included in the analysis, since Healthgrades also discards these patients from its algorithm as high risk for complications and mortality.1 Excel was used to analyze and uncover trends in this data based on date, DRG, and complications. Patients with the most common complications were further analyzed by looking at their medical records, including history and physical, lab test results, and physician’s notes. After initial analysis, more research into coding procedures was required to fully grasp areas for improvement. Hip and total knee replacement patients’ data from 2013 and 2014 were then analyzed to confirm trends in the found in earlier years and get a picture of what the Healthgrades rating will be in the furture. Results: After Microsoft Excel analysis of hip and total knee replacement data from Lehigh Valley Health Network patients from 2010 to 2014, the following results were obtained. Table 1: Rates of Complication Following Hip and Total Knee Replacement 2010 2011 2012 2013 2014 Hip 8.8% 5.5% 8.2% 7.1% 3.9% Knee 10.6% 7.6% 8.5% 8.0% 2.8% Table 1 shows the total complication rates for hip and total knee replacement surgery at Lehigh Valley Health Network from 2010 to 2014. Table 2: Complication Descriptions Coding Number Complication 998.59 Other Postoperative Infection 998.32 Disruption of External Operation 998.11 Hemorrhage 997.5 Urinary 997.49 Other Digestive System 997.4 Digestive System 997.39 Other Respiratory 997.1 Cardiac 997.09 Other Nervous System 997.02 Latogenic Cerebrovascular Infarction or Hemorrhage 996.42 Dislocation of Prosthetic Joint 867.0 Bladder or Urethra w/o Open Wound into Cavity 785.59 Shock w/o Trauma 584.9 Acute Kidney Failure, Unspecified 584.5 Acute Kidney Failure, Tubular Necrosis 518.81 Acute Respiratory Failure 507.0 Aspiration Pneumonia, Food or Vomit 486.0 Pneumonia, Organism Nonspecific 482.9 Bacterial Pneumonia, Unspecified 453.42 Acute DVT or Embolism, Distal Lower Extremity 453.41 Acute DVT or Embolism, Proximal Lower Extremity 453.4 Acute DVT or Embolism, Lower Extremity 428.33 Acute on Chronic Diastolic Heart Failure 428.31 Acute Diastolic Heart Failure 427.5 Cardiac Arrest 415.11 Latrogenic Pulmonary Embolism and Infarction 410.71 Subendocardial Infarction, Initial 410.51 Acute Myocardial Infarction Lateral, Initial 410.01 Acute Myocardial Infarction anterolateral, Initial 293.0 Delirium, Other Conditions 292.81 Drug-Induced Delirium 292.12 Drug-Induced Psychotic Disorder, Hallucinations 038.9 Unspecified Septicemia 038.43 Septicemia, Pseudomonas 038.42 Septicemia, Escherichia Coli Table 2 describes each complication based on its code. It includes all the complications in the hip and total knee replacement data obtained from 2010 to 2014 that patients developed after admission.7 Figure 1: Distribution of Complications from Total Knee Replacements Figure 1 shows the distribution of all complications from total knee replacement surgery from 2010 to 2012. Acute renal failure, 584.9, accounts for 39 percent of all complications and other respiratory problems, 997.39, accounts for 13 percent. Together, these two complications make up over half of all coded complications during this time period. Table 3: 584.9 and 997.** Complication Trends for Total Knee Replacement Complication 2010 2011 2012 2013 2014 584.9 4.9% 3.1% 2.3% 1.7% 1.3% 997.** 2.7% 0.7% 3.8% 4.7% 0.2% 997.39 0.3% 0.2% 3.0% 4.2% 0.2% Table 3 shows the percent of total knee replacement procedures that resulted in acute renal failure, complications affecting a specified body system, and other respiratory complications by year from 2010 to 2014. The instances of acute renal failures indicate a declining trend, while the instances of complications affecting a specified body system, particularly other respiratory complications, show a high spike in 2012 and 2013. Figure 2: Distribution of Complications from Hip Replacements Figure 2 shows the distribution of all complications from hip replacement surgery from 2010 to 2012. Acute renal failure, 584.9, accounts for 38 percent of all complications and other respiratory problems, 997.39, accounts for 17 percent. Together, these two complications make up over half of all coded complications during this time period. Table 4: 584.9 and 997.39 Complication Trends for Hip Replacement Complication 2010 2011 2012 2013 2014 584.9 4.4% 2.7% 1.5% 0.9% 1.0% 997.** 1.8% 1.5% 4.2% 4.9% 0.5% 997.39 0.0% 0.6% 3.3% 4.3% 0.0% Table 4 shows the percent of hip replacement procedures that resulted in acute renal failure, complications affecting a specified body system, and other respiratory complications by year from 2010 to 2014. The instances of acute renal failures indicate a declining trend, while the instances of complications affecting a specified body system, particularly other respiratory complications, show a high spike in 2012 and 2013. Conclusion: An in depth investigation of the medical records of 28 patients from both the hip and total knee replacement populations who suffered from either 584.9 or 997.39, the most frequent complications shown in Figures 1 and 2, did not yield significant results. There was not a standard way of measuring the change in creatinine or BUN levels to warrant coding acute renal failure versus a different complication. The same unstandardized and confusing method of diagnosing a respiratory complication was also evident. The decreasing trend of acute renal failure shown in Table 3 and 4, unspecified code is explained by the a change to CMS, Centers for Medicare and Medicaid Services, coding standards in October 2010 from 584.9 being classified as an MCC to a CC. An MCC is a major complication or comorbidity of surgery, while a CC is just a complication or comorbidity of surgery. This means that coding a 584.9 no longer increases the payment hospitals receive from insurance agencies, like Medicare, thus explaining the steady decrease in frequency of this code occurring. The decreasing trend continues in 2013 and 2014 with only around one percent of all hip and total knee replacement patients experiencing renal failure postoperatively. An exploration of coding procedures and standards over this date range indicated many misdiagnosed complications by outside contractors used in instances of backlogs, including 997.1, 997.39, 997.4, 997.49, and 997.5 codes. 997.** is not normally coded as a complication directly received from surgery, but rather just a conditions that arose post-operatively, unless it is specifically documented by the physician in the medical record. These complications make up 33 percent of total complications for hip replacements from 2010 to 2012 and 27 percent for total knee replacements. When looking at discharges from 2014 so far, only three cases have been assigned any of the 997.** codes. A reeducation process for all coding staff about the use of 997.** codes is underway. A prebilling initiative is being set up to catch any of these undesirable codes for orthopedic surgeries as well as acting as a second reminder for the coding staff not to use these codes. Additionally, no outside contractors have coded any of the cases in 2014 so far this year. These instances of inconsistent or incorrect coding are common in hospitals as proved earlier from the Northwestern University study. In a few years, once all the poor complication rates are eliminated from Healthgrades’ calculation, Lehigh Valley Health Network will have an orthopedic rating that accurately reflects the medical care provided. The rate of complications for total knee replacement in 2014 is below the national average from 2013 and for hip replacement it is only 0.5% above the national average. In future years, it would be beneficial to conduct the same analysis of complication rates to prevent more penalizing trends to continue for multiple years. Works Cited: 1. Rating Methodology. (2014). Retrieved June 2014, from healthgrades: https://www.cpmhealthgrades.com/index.cfm/solutions/products-services/quality-achievements-plus/ratings-methodology/ 2. Lehigh Valley Hospital - Cedar Crest. (2014). Retrieved June 2014, from healthgrades: http://www.healthgrades.com/hospital-directory/pennsylvania-pa/lehigh-valley-hospital-cedar-crest-hgstd26ae6a6390133?#Ratings 3. Mortality and Complications Outcomes 2014 Methodology. (2014). Retrieved from healthgrades: http://www.healthgrades.com 4. Rau, J. (2013, December 17). Medicare Identifies 97 Best And 95 Worst Hospitals For Hip And Knee Replacements . Retrieved July 2014, from Kaiser Health News: http://www.kaiserhealthnews.org/stories/2013/december/17/medicare-best-and-worst-hospitals-for-hip-and-knee-surgery.aspx 5. OrthoInfo. (2011, December). Retrieved June 2014, from AAOS: Association of American Orhtopedic Surgeons. 6. Avril, T. (2014, January 26). Debate over readmission data after joint replacements. Retrieved July 2014, from philly.com: http://articles.philly.com/2014-01-26/news/46641290_1_readmissions-medicare-eight-complications 7. Appendix C Complications or Comorbidities Exclusion list. (n.d.). Retrieved July 2014, from CMS: Center for Medicare and Medicaid Services: http://www.cms.gov/icd10manual/fullcode_cms /p0031.htm

Torsional Rotordynamics Of Machinery Equipment Strings

Short CourseOne of the foremost concerns facing rotating equipment users today is that of torsional vibration. In contrast to lateral vibration, torsional vibration is rarely monitored. As a result, torsional failures can be especially heinous since the first symptom of a problem is often a broken shaft, gear tooth, or coupling. In the past, torsional vibration problems were considered to be rare; however the number of torsional field problems has markedly increased recently with the advent of higher power, higher complexity variable frequency drives (VFDs). The increased risk plus the difficulty of detecting incipient failures in the field makes the performance of a thorough torsional vibration analysis an essential component of the turbomachinery design process. There are three primary objectives to this Short Course. First, it will provide users with a basic understanding of steadystate torsional vibrations, their potential for generating problems, and methodologies that are commonly used to analyze and avoid these problems. This portion of the course is aimed at younger, less experienced users, although veteran users will probably also benefit from the review. Second, it will provide users with some understanding of the more complex issues related to transient torsional vibration and acceptance based on stress analysis. Third, it will educate users on how VFDs work, and why they are a concern from a torsional standpoint. This portion will be beneficial to all users since modern VFDs are not well understood, especially by mechanical engineers. The course will be based on practical examples starting from the simple to the complex with some material based on a tutorial the lead author presented at this very show in 1996, Practical Design Against Torsional Vibration. Among the topics that will be discussed include description of torsional vibration, modeling, undamped analysis, Campbell diagrams, excitations generated by various mechanical and electrical components, steady-state and transient analyses, synchronous motor startups, and fatigue life analysis. At the conclusion of this portion, the user should have a good grasp of the fundamentals of this topic. A significant portion of time will be spent on VFDs. Topics covered will include VFD types, excitation frequencies generated by various VFDs, typical excitation amplitudes, control loop instabilities that can lead to problems, coupled electro-mechanical analyses, and design procedures for preventing VFD-related torsional issues up-front. At the conclusion of this course, all users should have sufficient understanding of the relevant concepts so that they should be able to take the proper steps to prevent torsional vibration problems from occurring in their equipment, even when their system contains a VFD

Identifying Best Practices Among Lay Health Educators

Background: The utilization of mammography has been shown to be lower in socioeconomically disadvantaged groups, which includes the African refugee community in Vermont. Mailed letters, telephone reminders, and massive media campaigns have proved ineffective at increasing rates of mammography screening in socioeconomically disadvantaged populations. However, a promising method to increase mammography screening is the use of peer educators to conduct home visits or group educational sessions. The Association of Africans Living in Vermont (AALV) has trained peer educators from the African community, known as Lay Health Educators (LHEs), to help increase mammography screening in this population.https://scholarworks.uvm.edu/comphp_gallery/1030/thumbnail.jp