Relocation of ORC to OR2

The goal of this Clinical Nurse Leader (CNL) internship project was to maintain safety and quality of care of obstetric (OB) patients undergoing Cesarean Sections (C/S) after operating room for cesarean sections (ORC) is relocated from obstetric unit to the main operating room (OR). The microsystem will accomplish this through effective teamwork, clear interdisciplinary communication, collaboration, and standardization of processes involved. The institution is a not for profit rural health care facility and is a designated Critical Access Hospital; it is located in Northern California. A general obligation bond was passed in 2007 to fund seismic upgrades. Old OB unit was housed in one of the oldest buildings on campus; new seismically compliant unit is being built from the ground up. Supportive data for the projects was collected through Failure Modes and Effects Analysis (FMEA) and process map flowcharts. Strengths, weaknesses, opportunities, and treats (SWOT) analysis of the microsystem was also performed. Relevant stakeholders were included in process development and continuous evaluation upon implementation. Literature review of evidence-based practice (EBP) reviewed decision to incision times and attainability of the 30 minute standard. Kurt Lewin’s Change Theory of unfreezing, moving, and refreezing provided foundation to support this process change. The entire process from planning to implementation, and evaluation is 16 months. The process was implemented on September 3rd, 2014. Clinicians have maintained quality and safety of patient care of obstetric patients undergoing cesarean sections in the new location. Plan do study act (PDSA) cycles have been used to continually monitor and modify process to ensure safety and quality of care

The Rise of the Industrial Rural Tenant Laborers and the Rise of the Industrial Economy: Historical Ethnography of the Heminitz Property ,Site (36LH267), Upper Macungie Township, Lehigh County,Pennsylvania

This paper presents the results of excavations at the Heminitz Property Site (36LH267), a rural domestic site in Upper Macungie Township, Lehigh County, Pennsylvania; Excavation, .\u27of several spatially and temporally discrete features and midden deposits in yards surrounding the house produced 6,875 artifacts. Documentary research revealed that the ca. 1843 house was intended to house tenant families engaged in agricultural labor. Analysis of the archaeological and documentary records associated with this site and the region shows that inthe mid-1800s, agricultural laborers possessed similar material. culture to neighboring independent farmers, while subsisting at a lower level of consumption. The transiiionfromagricultural to manufacturing labor occurred at the Heminitz Property Site in the mid-18/!Os, a time period\u27 that saw an increase in the quantity and value of domestic artifacts acquired by the site\u27s occupants. Archaeological and documentary data indicate that manufacturing laborers were materially betteT off than agricultural workers, though these benefits most likely came at the expense of chronic, low~l~erdebtto local storeowners. This investigation suggests the existence of a rural agrarian culture in\u27which individualsimd families could participate in differently, according to their particular economic circumstances

Carbon­yl[tris­(3,5-diphenyl­pyrazol-1-yl-κN 2)methane]copper(I) hexa­fluorido­phosphate–dichloro­methane–diethyl ether (4/3/1)

In the title compound, [Cu(C46H34N6)(CO)]PF6·0.75CH2Cl2·0.25C4H10O, the CuI atom is coordinated by three N atoms from the tridentate chelating tris­(3,5-diphenyl­pyrazol-1-yl)methane ligand (average Cu—N distance = 2.055 Å) and the C atom from a carbon monoxide ligand in a distorted tetra­hedral coordination geometry. The average N—Cu—N angle between adjacent pyrazole-ring-coordinated N atoms is 88.6°, while the average N—Cu—C angle between the pyrazole-bound N atom and the C atom of carbon monoxide is 126.3°. One of the 3-phenyl rings of the tris­(pyrazol­yl)methane ligand is disordered over two sites each with an occupancy factor of 0.50. The structure also exhibits disorder of the monosolvate that has been modeled with 0.75 CH2Cl2 and 0.25 Et2O occupancy

Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury

<p>Abstract</p> <p>Background</p> <p>The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning.</p> <p>Methods</p> <p>This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis.</p> <p>Results</p> <p>Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning.</p> <p>Conclusion</p> <p>This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.</p

Rationale and design: telepsychology service delivery for depressed elderly veterans

<p>Abstract</p> <p>Background</p> <p>Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas.</p> <p>Methods</p> <p>We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use).</p> <p>Discussion</p> <p>Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services.</p> <p>Trial registration</p> <p>National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).</p