Screening for Delirium in the Emergency Department

Abstract Delirium is a problem for many older adults who are acutely ill. Delirium often comes on suddenly, can be severe, and is often difficult to diagnose, especially in the presence of dementia. Missed delirium has a mortality rate of 30.8% and costs millions. What is the purpose of this study? Methods The 4A’s Test screening instrument was implemented and evaluated in the Emergency Department of a rural Midwestern hospital from May 1, 2019 through August 31, 2019. Results There were 122 participants in the study with 61 in each cohort. In 2018, three (5%) were diagnosed with delirium without a screening instrument. In 2019, 10 (6.1%) screened positive and were diagnosed with delirium. A Fisher’s exact test compared the 2018 and 2019 cohorts. The relationship between screening with or without a screening tool was statistically significant at the .05 level (p = 0.3227). A Fischer’s Exact Test was also performed on patients with and without previously diagnosed dementia. Twenty-two (36%) subjects had dementia and eight (13%) were positive with 39 (64%) subjects without dementia and seven (11.8%) screening positive. The relationship with and without a previous diagnosis of dementia was statistically significant at the 0.5 level (p= 0.2495). Implications for Practice The study found an 11.5% increase in recognition of delirium in the ED in general psychiatric presenting patients and an 18.5% increase in recognition of delirium in the ED in psychiatric presenting patients with a previous diagnosis of dementia

Strips

The PURPOSE OF THE THESIS is to utilize the human figure in movement as recorded over an extended period of time to create photographic panoramas of flowing, anamorphic design

Instrumental and Emotional Social Support Intention and Utilization Among Pregnant and Postpartum Women During the COVID-19 Pandemic

Postpartum depression impacts 1 in 7 women across the U.S. As a whole population, between 10-16% of women are impacted by maternal depression during pregnancy or the first year postpartum. Those who experience postpartum depression are at risk for repeated depressive episodes and a lower quality of life over time. The postnatal period may reflect the most vulnerable time for mental health concerns such as anxiety and depression. Fear, judgment, and perceived criticism are commonly named as barriers that delay the mobilization of support. There is a prevailing perception that postpartum depression is a normal part of motherhood which may limit women’s ability to seek and receive necessary care. The COVID-19 pandemic has impacted the day-to-day lives of pregnant women who are considered a high-risk group for poor clinical outcomes for COVID-19 infection. Loss of income, employment, and benefits due to pandemic restrictions are potential additional stressors that pregnant and postpartum women are burdened with navigating, which may increase risk of developing PPD. The influence of social support, social networks, and social integrations has been measured in a variety of ways. The terms are often used interchangeably to refer to the same concept: utilizing relationships to positively influence mental and physical health. The Stress Buffering Pathway acknowledges individuals may still experience stress or stress-related behaviors, but the utilization of social support can decrease the affiliation between stress and physical health outcomes. Postnatal social supports can range from lactation consulting, contraceptive counseling, maternal support services, and even support groups. This study utilized an extant data set (n = 239) from the research study, “Pregnancy and Childbirth During a Pandemic: The Impact of COVID-19.” A quantitative non-experimental cross-sectional design was conducted to explore associations among loss of expected social support and postpartum Edinburgh Postnatal Depression Scale (EPDS) scores. Results from the measures indicate a significant result of impact from loss of expected social support and increased postpartum EPDS scores. The results of this study may influence further action and research into sustaining maternity support services and programs for the pregnant and postpartum population

The Influence of Stressful Life Events on the Development of Type 2 Diabetes

This study examined the relationship between distress and the development of Type 2 diabetes mellitus (T2DM) in the presence of established risk factors. Distress secondary to mental health disparities, stressful life events, and work conditions has been shown to promote insulin resistance and the development of T2DM. Subjects (N=79) diagnosed with T2DM within the previous six months were recruited from SSM Health Centers and VA Medical Centers in the greater St. Louis area. They completed the Recent Life Changes Questionnaire, ENRICHD Social Support Instrument, and a demographic survey and analyses were conducted to determine differences between the veteran and non-veteran subsamples, as well as determine the influence of distress and social support in the presence the established risk factors of age, BMI, and genetic risk for diabetes. The average subject’s hemoglobin A1c (HbA1c) was 8.3%, BMI was 34.1, ESSI score was 15, and RLCQ score was 297.6 LCU. Twenty-nine subjects were diagnosed with a mental illness. Age and BMI had significant influence on the development of T2DM for the sample (β=-.241, p=.031 and β=-.293, p=0.10, respectively) while distress was not significant (β=-.040, p=.721). The mean HbA1c for the subgroups were significantly different (t=2.768, p=.007) The differences in age, BMI (t=-1.158, p=.250), GRD (t=-1.279, p=.206), and RLCQ scores (t=-.487, p=.628) were not significantly different

Ethereum and the SEC: Why Most Distributed Autonomous Organizations are Subject to the Registration Requirements of the Securities Act of 1933 and a Proposal for New Regulation

In a world full of new technology, the risk of fraud is constantly increasing. In the securities industry, this risk existed long before the use of technology. Congress enacted the Securities Act of 1933 to combat the risk of fraud and misrepresentation in the sale of securities. By requiring full disclosure, investors have the opportunity to make informed decisions prior to investing. However, Distributed Autonomous Organizations (“DAOs”), through the use of blockchains and smart-contracts, engage in the sale of securities without fully disclosing the risks or complying with the registration requirements of the Securities Act of 1933. Compliance with the burdensome requirements of registration, however, would destroy this new technology and method of conducting business. To avoid this set-back, Congress must amend the registration requirements to provide an exemption for DAOs. This exemption, although reducing current registration burdens, must still require DAOs to disclose certain information, thereby ensuring investors are informed prior to investing. Furthermore, due to the unique nature of the blockchain, smartcontract, and DAOs, Congress must impose a fiduciary duty on the creators of DAOs to ensure compliance with the disclosure requirements. Further, Congress should consider the allowance of burden-shifting following the initial crowdsale

Selected risk factors contribute to homelessness among youth : a comparative study of Chile and the United States

Youth who are at-risk of homelessness are placed into jeopardizing situations because they are often pushed toward the outer edges of society, disconnected from healthy support networks, involved in illegal activities, and their chances of having successful futures are, in turn, diminished. The goals of this project were to: review current literature of homelessness among youth in the United States and Chile and identify parallel risk factors occurring in both countries; determine causes and effects of selected risk factors; and identify methods cited in the literature that may prevent the occurrence of selected risk factors, and provide them to one social welfare agency in each of the two countries (SEDEJ and JSYSI). In order to identify these risk factors, I chose to conduct a literature review which resulted in the following: substance abuse, lack of education, single parent household, low social class, childhood abuse, mental illness, involvement in criminal activity, and lack of healthy support networks. I subsequently decided to conduct interviews with Chilean and American social workers so that I could determine whether the literature corresponded with actual experience. These interviews proved there to be a strong correlation between the literature and experiences that the social workers have had while working with youth who are at-risk of homelessness. Although I discovered many parallels in my research about the populations of at-risk youth in Chile and the United States, I also observed several differences that clearly relate to the cultural values that are distinct to each of these countries

Parameter analysis of induction motor equivalent circuits

Práce se zabývá určením parametrů asynchronního motoru pro náhradní zapojení ve tvaru T článku, -článku a -článku z měření naprázdno a zjištěním napěťové závislosti parametrů. Pro každé z těchto zapojení stanovuje závislosti momentu a statorového proudu na skluzu. Pomocí programu MATLAB jsou díky simulacím teoreticky odvozené závislosti srovnány se skutečnými, změřenými na motoru s kotvou nakrátko o výkonu 0,6 kW, 2p = 2, a to jak v pracovní, tak i v celé motorické oblasti.This work deals with the determination of the parameters of induction motor equivalent circuits in T-network, gamma-network and inverted gamma-network form from no-load test and discovering voltage dependence of these parameters. For each of these circuits are determined dependencies of the torque and the stator current on the slip. Using the MATLAB simulations, the theoretically derived dependencies are compared with real, which are measured on the motor with the squirrel-cage rotor with power 0,6 kW, 2p = 2, both in operating and in whole motor area.

IndieBook

Ausgehend vom Wunsch als Leser und Leserin Geschichten mit zu gestalten, präsentiert diese Diplomarbeit das theoretische Konzept IndieBook für ein System zur Generierung fiktiver Welten für individualisierte Bücher. Die ideelle Basis von IndieBook bildet das kollaborative Einwirken von Autor, Leser und Computer in den Generationsprozess: Der einzigartige Stil des Autors bestimmt die statischen Voreinstellungen. Über interaktive Wahlmöglichkeiten und personalisierte Informationsquellen bringt sich der Leser ein. Das System fügt dies zusammen und generiert daraus Narrationen. Voraussetzung dafür ist eine grundlegende Formalisierung fiktiver Welten. Dafür wurden Modelle aus der Narratologie, Kognitionswissenschaft und Soziologie herangezogen und mit Techniken der Informatik formalisiert. Nach allgemeinen Voreinstellungen werden die Weltmodelle über die Realitätsrelationen und den daraus resultierenden Fiktivitätsgrad generiert. Die eigentlichen Bestandteile der Welt sind das Setting, die Charaktere und die Ereignisse. Das sozial-historisch-räumliche Setting konkretisiert die Relationen zu einem Rahmen für die Charaktere und Ereignisse. Die Charaktergeneration erfolgt in einem 6-stufigen Modell, das in einer detailierten, strukturierten Datenbank für jede einzelne Figur resultiert. Nach der Formalisierung der verschiedenen Formen von Ereignissen, wurde deren Narrativität und Struktur diskutiert.Based on the wish of many readers to co-create a story, this diploma thesis presents a theoretical concept called IndieBook to generate fictive worlds for individualized books. The idea behind IndieBook is the collaboration of author, reader, and computer in the generation process: The unique style of the author provides the static defaults. Then, the reader interacts through a range of possibilities and personalized information is integrated. Finally, the system merges these inputs and defaults and generates narrations. One major condition for this concept is a fundamental formalization of fictive worlds. Therefore, models were adopted from Narratology, Cognitive Science, and Sociology, modified to meet the requirement, and formalized with techniques of Computer Science. After the general presettings, the world models are generated through their relations to the reality and the resulting degree of fictivity. On this foundation, the components of the world are established: the setting, the characters, and the events. The socio-historico-spatial setting concretizes the relations and works as a referential frame for the characters and events. The generation of characters proceeds in a 6-layered model, that results in a detailed, structured data base for each protagonist. After formalizing the modes of events, the tellability and structure of events were discussed