Improving Documentation In Shoulder Dystocia

Shoulder dystocia (SD) is difficult to predict and one of the most highly litigated obstetrical emergencies. Consequently, our institution implemented a standardized SD form in order to help facilitate adequate and accurate documentation in cases of SD. Our study aimed to utilize the information recorded in the newly implemented SD form to investigate the demographics of patients, practices, and outcomes in SD cases at Yale-New Haven Hospital (YNHH) and to study the effect of implementing a standardized SD form on medical record documentation practices. We collected 41 discrete data points from the SD form and the medical record in cases of SD occurring at our institution. We identified SD cases beginning in January 2004 and tracked inclusion of delivery information in the SD form and in narrative delivery notes for one year before and four years after implementation. Overall, 152 consecutive cases of SD were included and the presence as well as the mean and standard deviation, or percentage, for each data point was collected and calculated. Elements from the SD form increased significantly in narrative delivery notes after implementation of the form (p=.011). Data elements included at higher rates in the medical record after implementation included estimated prepregnancy maternal weight (13% to 28%, p=.043), total maternal pregnancy weight gain (19% to 36%, p=.033), estimated fetal weight (60% to 77%, p=.025), time of onset of active labor (40% to 65%, p=.004), time of onset of second stage (27% to 52%, p=.003), and time of head delivery (4% to 30%, p=\u3c.001). The demographics of our patient population were comparable to that of others reported in the literature. Our results show that use of a mandatory SD form results in significant improvements in documentation within provider narrative delivery notes and may improve the attention of providers to more complete and accurate charting. Such improvements in documentation may better demonstrate standards of care in the management of SD cases and decrease litigation exposure when events are reviewed

Corrosion performance of zirconium-based passivations on electroplated zinc nickel

“Performance requirements for Department of Defense (DoD) electrical components include corrosion and electrical contact resistance. Historically, electroplated cadmium with a chromate conversion coating (CrCC) has been used to meet corrosion and contact resistance standards. However, replacements are needed for these materials because they are toxic and carcinogenic. Electroplated γ-ZnNi has been identified as an acceptable alternative to Cd. This study evaluated commercially available Zr-based thin films and sealers as passivations for potential replacement of CrCCs. Ten different passivations were tested and compared with bare γ-ZnNi. X-Bond and Zircobond passivations were found to provide some improvement to the bare ZnNi corrosion performance, but none of the evaluated coatings met the requirements for DoD electrical connectors. Bare ZnNi, X-Bond 3000, and Chemseal 59 were able to meet the electrical contact resistance requirement of \u3c 5 mΩ/in2 before salt spray exposure, but none of the samples were able to meet the post salt spray exposure contact resistant requirement of \u3c 10 mΩ/in2. The corrosion performance of the X-Bond coatings was more heavily influenced by surface preparation than coating chemistry variations, with improvement observed upon using an alkaline cleaner. On the other hand, Zircobond 4200 coatings were negatively influenced by an alkaline cleaner and also a deoxidizer but saw some improvement with the use of Zircoseal on top of the standard coating. Chemseal 59 provided improvement when directly applied to the bare γ-ZnNi but degraded corrosion performance when applied to the Zircobond 4200. Overall, the X-Bond coatings showed the most promise having the least corrosion product and contact resistance”--Abstract, page iv

Are Hormone Therapies More Effective in Treating the Manifestations/ Symptoms of Menopause than Lifestyle, Exercise, and Diet Changes?

For many women, menopause is a topic that is not discussed until they reach the age of 45 and begin to experience symptoms such as hot flashes and night sweats. Because of the taboo associated with menstrual cycles and female reproductive health, many women suffer in silence and are not aware of the various treatment options that are available to aid with the subsidence of their symptoms. These various treatment options range from medications such as hormone-replacement therapies, vitamin and mineral supplements, and changes in diet and exercise. For this presentation, the research that was conducted focused on hormonal therapies and lifestyle changes. Through the background research that was completed, it was hypothesized that hormonal therapies provided patients with improved outcomes compared to lifestyle changes. Hormonal therapies can be used to treat a range of symptoms and conditions for women who are considered to be in menopause. Due to the decreased levels of estrogen and progesterone that are produced by the body, women may experience a worsening of symptoms as they age. Under the category of hormonal therapies, there are several options such as estrogen supplements, herbal oils, CBD oil, vitamin and mineral supplements, and various other medications that can be prescribed to treat specific side effects of menopause. Some women prefer to not take medications or consume hormones and opt to alter their lifestyle in order to improve their symptoms. Small changes such as increasing exercise, altering diet to exclude saturated fats and processed foods, and getting enough sleep can cause some women to experience an improvement of their symptoms. Other changes that may be helpful include eating smaller meals throughout the day instead of consuming 3 larger meals. Through a literature review of many reputable sources, it was concluded that hormonal therapies when compared to lifestyle changes decrease the symptoms which women who are in menopause may experience

The Effects of Oklahoma\u27s Universal Preschool Policy on Long-Term Educational Outcomes for Students

As states have increased their commitment to early childhood education over the past two decades, a debate on the efficacy of state-sponsored universal preschool has divided policymakers, administrators, and taxpayers. Some critics of these programs argue that universal preschool has a diminishing impact which does not justify the up-front cost, while supporters argue that there are long-term positive effects of high quality, universal early childhood education which outweigh the cost. In this paper, we examine the effect, if any, that the existence of a state-funded universally available preschool program has had on county-level average ACT scores in a before-and-after multivariable regression analysis. This analysis was then expanded to include analysis on the impact of universal preschool on ACT scores for low-income student populations and high-enrollment student populations. We found that the existence of a universally available preschool program had a statistically significant positive effect on students and that the impact on ACT Scores was higher for low-income students

Cultural Transformation of Schools With Challenging Environments and At-risk Populations

Learn how any school (k-12) can use the Character Education Partnership’s (CEP) 11 Principles of Effective Character Education to transform culture resulting in increased attendance and academic achievement with decreased behavioral problems. Attendees will hear how specific high-risk schools decreased bullying, increased morale, and impacted their communities through the development of a school Touchstone, service learning, and advocate families

Cogeneration System Comparison for the Akron Water Treatment Plant

Cogeneration is a process of electrical power generation that simultaneously harnesses the heat produced from that electrical generation and uses it to supply heat to a space. The Akron Water Plant was identified as potentially benefitting from this technology for two main reasons. First, they have a large and relatively constant electrical load. Second, they have ownership of a significant amount of natural gas wells at the site. This report analyzes the economic feasibility of installing a cogeneration plant at the Akron Water Plant (AWP). Data was collected for the plant and its operations, including electricity bills, gas bills, plant layout, current heating and cooling methods, natural gas well capacities, and lease agreements. Based on this information, primarily the electrical consumption of the plant, cogenerators manufactured by 2G Energy were selected as the basis of design for the analysis. A cogeneration plant sized for the electrical consumption of the plant leads to significantly more waste heat than could be utilized to heat the AWP facilities. However, after studying the operation of the system, it became apparent that the cogenerator requires more fuel than the AWP wells have the capacity to produce. Nonetheless, the study was continued on the assumption that the wells did have the required capacity in order to study the economic feasibility of cogeneration systems in general. Price estimates were generated for each of the four proposed cogeneration configurations, including all costs required to update the plant from electric baseboard and gas heating to the hydronic heating provided by the cogenerator, and a payback analysis was performed to better understand the feasibility of each option. The results of this analysis are displayed in the table below. In conclusion, a cogeneration system may not be feasible for AWP due to the limited availability of natural gas; however, this study was useful in showing the feasibility of cogeneration plants as a concept. Should a facility have a larger gas well available, or even another fuel source capable of supplying the cogenerator, then cogeneration can provide enormous energy savings and appears to be a viable system

Demographics and Physical Activity Levels of eSports Athletes at The University of Akron

Esports is rapidly growing and gaining popularity, however there is a lack of research regarding physical activity levels of eSport athletes, especially those at the collegiate level. This study summarizes the current research and findings related to exercise, overall health, and video game performance. All varsity eSport athletes for The University of Akron varsity team were “participants” in this study. A survey tool was designed through Qualtrics (Qualtrics 2020© Provo, UT), an online survey instrument, to assess current physical activity levels, preferences and tolerance for exercise intensity, and perceptions about how physical activity affects gaming performance. This survey was distributed to The University of Akron eSports varsity team. However, due to the Coronavirus COVID-19 pandemic of 2020, the results were unable to be collected and analyzed. This survey instrument can serve as a baseline for further research on this topic, particularly concerning eSports training programs

PILOTING ETHICS-FOCUSED DEBRIEFING TO ADDRESS NURSE MANAGER MORAL DISTRESS: A QUALITY IMPROVEMENT PROJECT

INTRODUCTION: Nurses and their patients are both affected by moral distress. Few studies have addressed moral distress among nurse managers. Debriefing is a potentially effective intervention for addressing moral distress. The purposes of this pilot quality improvement project were twofold: 1) to optimize and embed an ethics-focused debrief for nurse managers into a weekly nursing leadership meeting to reduce manager moral distress levels and 2) to encourage use of debriefing to address moral distress among frontline nurses.METHODS: Participants in a large academic Southeastern health care system completed the Measure of Moral Distress for Healthcare Professionals (MMD-HP) to measure baseline distress. The project lead implemented eight debriefs in four Plan-Do-Study-Act cycles and measured distress before and after debriefing, as well as debriefing practices among participants. RESULTS: Moral distress levels tended to decrease following the debriefing session, although differences were not statistically significant. There was a strong positive correlation between manager comfort level facilitating debriefs and quantity of debriefs conducted by the participant. CONCLUSION: Additional research is needed to understand how debriefing is most effective for reducing moral distress within organizational context.Doctor of Nursing Practic

Sports Analytics in NCAA Division III Men’s Soccer: A Case of Practical Application of GPS Metrics

Sports performance analysis has become an essential tool for coaches as it provides evidence for more educated decisions. However, objective measurement is essential for that process. Recently, GPS metrics have become very popular in soccer as they provide quantifiable data on identified key performance indicators (KPIs). Making inferences from raw data is a common challenge for practitioners. PURPOSE: To analyze and interpret the game data from 2020-21 season to answer the head coach’s questions of a) What is the profile per position (Center Back, Full Back, Deep Midfielder, Winger, Attacking Midfielder, and Striker) based on seven specific KPIs identified by the coach (GPS Training Load, Total Distance, Sprint Total Distance, Sprint Count, Sprint Average Speed, Explosive Effort Count, and Top Speed)? and b) Are there significant differences in those profiles between losses and wins? METHODS: All 29 players agreed to participate. Data were collected using the Titan 1+ GPS sensor. After differentiating practice from game data (n = 16), we created profiles per position based on the aforementioned KPIs. We, then, explored differences between the eight wins and the seven losses (the one tied game was excluded from the second part of the analysis). We converted all raw scores to Z scores, so the scale would be the same across all variables and easier to present to the coaching staff. Therefore, all differences are in SD units (i.e., effect size). RESULTS: Due to space limitations, we are presenting results for the position of the Deep Midfielder as an example. All games: GPS Training Load = 0.02; Total Distance = 0.31; Sprint Total Distance = -0.29; Sprint Count = -0.32; Sprint Average Speed = -0.38; Explosive Effort Count = -0.32; and Top Speed = -0.40. Wins: GPS Training Load = 0.23; Total Distance = 0.80; Sprint Total Distance = -0.37; Sprint Count = -0.41; Sprint Average Speed = 0.00; Explosive Effort Count = -0.40; and Top Speed = -0.08. Losses: GPS Training Load = -0.01; Total Distance = -0.02; Sprint Total Distance = -0.06; Sprint Count = -0.08; Sprint Average Speed = -0.40; Explosive Effort Count = -0.08; and Top Speed = -0.38. CONCLUSION: The coaching staff will use these findings to adjust practices per position for the 2022-23 season. According to the ACSM worldwide survey, wearable technology is the number one fitness trend for 2022. Division III (DIII) schools are the biggest participant in the NCAA. In terms of the number of student-athletes, soccer is the second most popular sport in the NCAA. This case study could have numerous practical implications as it demonstrates how sports data analysts and sports practitioners can collaborate in sports performance analysis

Show Me and What Will I Remember? Exploring Recall in Response to NWS Tornado Warning Graphics

It is critical that organizations deliver timely, effective communication about potential risks and life-saving information. The National Weather Service (NWS) developed a suite of messages known as “experimental graphic products” to be automatically distributed through their local official Twitter accounts at the onset of fast-moving, severe weather events such as tornadoes. However, recent research has suggested messages need to be carefully constructed for audiences to place attention to the content, remember the content, and later act in response to the content. The purpose of this study is to explore what people recall of the NWS Twitter message. We used an online survey instrument, distributed via Qualtrics, to investigate participant responses to three open-ended questions about the message. We performed a quantitative analysis to summarize the frequency of message features recorded by participants, and a qualitative analysis to identify themes that provide a deeper description of what was recalled. We found that participants encoded the hazard type, the time the message was sent and would expire, and the types of impacts that might occur. Graphic design cues elicited attention as they “stood out” to the participants. When asked about importance and what they would tell others, respondents described protective action, indicating participants may have activated prior knowledge of the threat, as it was not included in the message. Risk, disaster, and science communicators can draw guidance about communicating during a disaster. It provides a lens for researching message construction, and the importance of communicating protective action guidance during severe weather events