Reducing Falls Related to Toileting

Practice Problem: The practice problem for the medical-surgical unit is a high rate of falls associated with toileting activities, despite universal fall precautions for all patients. The current fall rate is an average rate of 4 falls per 1,000 patient days. PICOT: The PICOT question that guided this project was: Among adult patients in the inpatient medical-surgical unit (P), what is the effect of adding a toileting care plan (I) to the current practice of universal fall precautions (C) to reduce the severity and incidence of falls (O) within an 8-week period (T)? Evidence: Nine high-quality articles supported a toileting care plan encompassing patient-centered fall interventions could decrease falls and falls with injuries. Interventions: Staff education on risk for patient falls, individualized risk assessments for falls, individualized toileting care plan, and effective handoff communication to all bedside staff about risks for falls. Outcome: The desired reduction in the rate of falls was not achieved during the intervention period; however, the project highlighted organizational challenges related to coordination of change, staffing, and unit participation. Further increased knowledge and utilization of the Morse fall risk assessment tool, resource allotment for fall reduction programming, and reprioritization for organization review of skills related to toileting plans was achieved. Conclusion: Clinical significance was achieved with this EBP project, even without the overall goal achievement of a reduction in fall rates on the pilot unit. The project highlighted the need for organizational readiness for change, effective strategy for concurrent priorities, and agility for unanticipated confounders, such as significant staffing concerns

Multilingual Writers in the Mexican Sociocultural Context: Towards Improved Pedagogical Practices in the U.S.

Currently, the education of Latina/o students in the United States for higher education and future careers comprises multiple moving parts. As the U.S. educational system, in particular the Pre-K-12 years of schooling, struggles despite efforts to address the needs of all students, both native English speakers as well as English language learners (ELLs), to better prepare them to enter institutions of tertiary education and succeed in careers, various organizations and consortiums articulate more rigorous educational standards (WIDA and the Common Core Standards as two examples). These recent proposals focus on academic literacy skills, in particular on reading and writing skills development from the earliest years of elementary school. Further evidence in both print and radio media of the emphasis on academic skills and high stakes testing appear in the public statements of the new CEO of the College Board. David Coleman, for example, has articulated his vision of a new SAT writing section that requires test takers base their writing samples on sources provided by the test developers. Mr. Coleman explains that the test takers should be asked to write a source-based paper in line with contemporary writing practices rather than an opinion-based, five-paragraph essay, a reminder of dated Anglo-American composition traditions. He even goes so far as to claim that SAT test questions will include questions on the mechanics of writing such as punctuation, citations, and paragraphing conventions

Plagiarism and Academic Writing of Learners of English

Incidents and anecdotal evidence accrue of learners’ resorting to plagiarism in their essays and research papers. There seem to be three possible reasons that plagiarism is common among students writing in English as a second language. First is the desire to cut corners. Second, there are differences in cultural practices. Third, the learners have a lack of skills and/or language proficiency. We wanted to begin to document the actual situation in Japan. Therefore, we decided to conduct an ethnographic type of study in which we would seek evidence from a variety of sources. Although we focused our attention on written assignments of learners within the classroom context, specifically examining plagiarising the work of others, we also examine the broader social context

LOCAL FIELD POTENTIAL ANALYSIS OF BEHAVIORAL TASK INDUCED PLASTICITY IN HIGHER-ORDER AUDITORY CORTEX

Previous studies have shown attention related transient changes induced during auditory discrimination behavioral tasks in primary auditory cortex (A1). This study involved awake, behaving ferrets performing similar auditory tasks with negative reinforcement; however, recordings were focused on higher-order cortical areas to understand what, if any, plastic effects exist and how they compare with A1. Although neurons in the posterior ectosylvian gyrus (PEG) exhibit similar tuning properties and conform to a tonotopic mapping consistent with prior findings, these areas enhance selectivity to target stimuli. The neurophysiological recordings from A1, PEG, and frontal cortex were then compared using the local field potential (LFP). This analysis focused on the response-power changes within these recordings and findings were consistent with single unit trends

Using Disability Studies in Education (DSE) and Professional Development Schools (PDS) to Implement Inclusive Practices

This article highlights ways in which disability studies in education (dse) and professional development school (pds) partnerships can be used to provide students with disability labels more access to inclusive classrooms. The authors of this qualitative exploratory case study interviewed 16 teacher and administration pds steering committee members to better understand how students with disability labels could be supported through the development and implementation of dse-informed inclusive practices. The findings indicate that instituting proactive communication structures, providing ongoing dse-informed professional development to teachers, administration, and staff, and teachers taking inclusive action increased the number of students with disability labels accessing general education classrooms. These findings, while a work in progress, show how members of one pds steering committee took steps to resist deficit models of disability and questioned traditional segregated approaches to special education at their school

Barreiras de impermeabilização: configurações aplicadas em aterros sanitários

With the growth of cities and expansion in the generation of municipal solid waste are becoming increasingly common the presence of landfills. These landfills must be made with waterproof barriers (liners) able to contain leachate, thereby preventing scattering of contamination plumes. In this sense, this study aims to list the major liners found in landfills, presenting their features, in addition to exposing examples applied in landfills across the country. To this end, it conducted a literature finding the different existing liners and their respective peculiarities. With the study we observed the presence of waterproof barriers consist of: geosynthetics, sludge, active barriers, municipal solid waste, benthic geocomposite, soil cement or compacted soils. It was also found that some Brazilian cities, as the case of Belo Horizonte, use to disposal landfill waste with the presence of alternative waterproofing layers. As a whole, the liner with the highest security among the classes studied were the geosynthetic liners combined with compressed ultisols, thus presenting lower permeability.Com o crescimento das cidades e ampliação na geração de resíduos sólidos urbanos tornam-se cada vez mais comuns à presença de aterros sanitários. Estes aterros devem ser elaborados com barreiras impermeabilizantes (liners) capazes de conter lixiviados, evitando assim espalhamentos de plumas de contaminação. Neste sentido, o presente estudo visa elencar os principais liners encontrados em aterros sanitários, apresentar suas características, além de expor exemplos aplicados em aterros pelo país. Para tanto, foi realizado um levantamento bibliográfico constatando os diferentes liners existentes e suas devidas peculiaridades. Com o estudo observou-se a presença de barreiras impermeabilizantes constituídos por: geossintéticos, lodos, barreiras ativas, resíduos sólidos urbanos, geocomposto bentônico, solo cimento ou solos compactados. Verificou-se ainda que algumas cidades brasileiras, como o caso de Belo Horizonte, utilizam para disposição de resíduos aterros sanitários com a presença de camadas impermeabilizantes alternativas. Como um todo, o liner que apresentou maior segurança entre as classes estudadas foram os liners de geossintéticos combinados a argissolos compactados, apresentando assim menor permeabilidade

Integrative motivation in a globalizing world

This article reports on research into the motivation of Indonesian children aged 11–12 years old, as they begin formal study of English in an urban junior high school. The research used closed and open questionnaire items, backed up by class observations and interviews with a selected group of learners. Very high levels of motivation to learn the language were found throughout the cohort, including both integrative and instrumental orientations, but these two traditionally distinct constructs were found to be almost indistinguishable. The article argues that as English loses its association with particular Anglophone cultures and is instead identified with the powerful forces of globalization, the desire to ‘integrate’ loses its explanatory power in many EFL contexts. Individuals may aspire towards a ‘bicultural’ identity which incorporates an English-speaking globally-involved version of themselves in addition to their local L1-speaking self. It is speculated that changes in individuals' motivation to learn the language may therefore be partly explained by reference to ongoing processes of identification, especially during the formative years of adolescence

Ongoing studies on the bats of Danum Valley Borneo

Here we provide an update on the batting activities of the James Cook University's biannual undergraduate field trip to Danum Valley Field Centre in Borneo. The 2013 trip focussed on various bat surveying techniques, with an emphasis on the use and effectiveness of the EM3 full-spectrum and Anabat II ZCAM ultrasonic detectors. We captured a total of thirty-three individuals of 12 different species in harp traps and mist nets, three species of which had not been encountered on previous surveys. We collected an additional 16,500 call files and in total, we now have a call library of 43 microbat species (of which 28 can be allocated to individual species) along with high-quality photographs of 20 micro- and megabats. It will be no surprise that Terry Reardon also took dynamic photographs of individuals in flight upon release, and generously donated his flash-setup to the staff of Danum Valley. Future field trips will continue to build the call and photo library as well as collect tissue samples for collaborative studies with scientists in Malaysia and Australia. We plan to make the calls and photos available via an open-access WWW page

MRI Analysis of White Matter Myelin Water Content in Multiple Sclerosis: A Novel Approach Applied to Finding Correlates of Cortical Thinning

A novel lesion-mask free method based on a gamma mixture model was applied to myelin water fraction (MWF) maps to estimate the association between cortical thickness and myelin content, and how it differs between relapsing-remitting (RRMS) and secondary-progressive multiple sclerosis (SPMS) groups (135 and 23 patients, respectively). It was compared to an approach based on lesion masks. The gamma mixture distribution of whole brain, white matter (WM) MWF was characterized with three variables: the mode (most frequent value) m1 of the gamma component shown to relate to lesion, the mode m2 of the component shown to be associated with normal appearing (NA) WM, and the mixing ratio (λ) between the two distributions. The lesion-mask approach relied on the mean MWF within lesion and within NAWM. A multivariate regression analysis was carried out to find the best predictors of cortical thickness for each group and for each approach. The gamma-mixture method was shown to outperform the lesion-mask approach in terms of adjusted R2, both for the RRMS and SPMS groups. The predictors of the final gamma-mixture models were found to be m1 (β = 1.56, p \u3c 0.005), λ (β = −0.30, p \u3c 0.0005) and age (β = −0.0031, p \u3c 0.005) for the RRMS group (adjusted R2 = 0.16), and m2 (β = 4.72, p \u3c 0.0005) for the SPMS group (adjusted R2 = 0.45). Further, a DICE coefficient analysis demonstrated that the lesion mask had more overlap to an ROI associated with m1, than to an ROI associated with m2 (p \u3c 0.00001), and vice versa for the NAWM mask (p \u3c 0.00001). These results suggest that during the relapsing phase, focal WM damage is associated with cortical thinning, yet in SPMS patients, global WM deterioration has a much stronger influence on secondary degeneration. Through these findings, we demonstrate the potential contribution of myelin loss on neuronal degeneration at different disease stages and the usefulness of our statistical reduction technique which is not affected by the typical bias associated with approaches based on lesion masks