Improving Discharge Planning Using the Re-Engineered Discharge (RED) Program

The 12-actionable items of the Re-Engineered Discharge Program (RED) are equipped to address essential areas to prevent hospital re-visits. Evidence supports the use of nurses to complete these essential components of hospital interventions. The aims of this project were to: 1) assess nurses’ readiness to learn prior to receiving education on the RED Program, and 2) measure the utilization of the RED discharge process from patient chart reviews following an educational intervention focused on the RED 12-actionable items. Participants (N = 69) scored high M = 219.8 (SD 23.7) on the Self-Directed Learning Readiness – Adult Scale, indicating the nurses had high self-directed readiness to learn prior to the educational intervention. Chart reviews found that utilization of the 12-actionable items pre-intervention, (n = 60) M = 6.55 (SD 1.478) compared to post-intervention (n = 60) M = 10.08 (SD 1.544) indicated a statistically significant improvement in discharge planning (t = 17.730, p = .000 (CI 3.13 – 3.93). The study supports that RED discharge program focused education sessions for nurses with higher levels of self-directed readiness to learn are effective in promoting improvement in discharge planning

Impact of a Modified Early Warning Score Tool on Nurses’ Ability to Recognize and Respond to Clinical Deterioration

Timely recognition of signs of impending clinical deterioration in acute care hospitalized patients can prevent an unexpected illness from becoming a fatal event. Failure to recognize the precursors of impending doom can have many factors, but the most influential of these is the role of the bedside nurse in detecting the subtle signs of decline. The Modified Early Warning Score (MEWS) has been used successfully to detect clinical deterioration in hospitalized patients, while simulation has been used successfully to provide an environment to test reaction to acute patient decline without harm to actual patients. A translational research project implemented the MEWS tool through an educational intervention that included simulated patient experiences. The aims of this project were to 1) increase awareness of bedside nurses to acute patient deterioration in the rural hospital setting and 2) increase action of bedside nurses to acute patient deterioration in the rural hospital setting. Results indicate that use of the MEWS increases nurses’ use of other deterioration screening tools as well as their knowledge and confidence in responding to a deterioration event. The usefulness of simulation as a method to provide education in post-licensure nurses is also discussed. Finally, the MEWS tool was shown to accurately predict patient deterioration of hospitalized clients if completed consistently. Future research should focus on how to increase usage of deterioration tools to detect acute clinical decline earlier in the deterioration process

Magneto-Acoustic Wave Oscillations in Solar Spicules

Some observations suggest that solar spicules show small amplitude and high frequency oscillations of magneto-acoustic waves, which arise from photospheric granular forcing. We apply the method of MHD seismology to determine the period of kink waves. For this purposes, the oscillations of a magnetic cylinder embedded in a field-free environment is investigated. Finally, diagnostic diagrams displaying the oscillatory period in terms of some equilibrium parameters are provided to allow a comparison between theoretical results and those coming from observations.Comment: 10 pages, 4 fig

Doppler shift oscillations in solar spicules

Consecutive height series of Ha spectra in solar limb spicules taken on the 53 cm coronagraph of Abastumani Astrophysical Observatory at the heights of 3800-8700 km above the photosphere have been analyzed. The aim is to observe oscillatory phenomena in spicules and consequently to trace wave propagations through the chromosphere. The Discrete Fourier Transform analysis of Ha Doppler shift time series constructed from the observed spectra at each height is used. Doppler velocities of solar limb spicules show oscillations with periods of 20-55 and 75-110 s. There is also the clear evidence of 3-min oscillations at the observed heights. The oscillations can be caused by wave propagations in thin magnetic flux tubes anchored in the photosphere. We suggest the granulation as a possible source for the wave excitation. Observed waves can be used as a tool for spicule seismology; the magnetic field strength in spicules at the height of about 6000 km above the photosphere is estimated as 12-15 G.Comment: 7 pages, 8 figures, accepted in A&

Epidemiologic Differences Between Cyclosporiasis and Cryptosporidiosis in Peruvian Children

We compared the epidemiologic characteristics of cyclosporiasis and cryptosporidiosis in data from a cohort study of diarrhea in a periurban community near Lima, Peru. Children had an average of 0.20 episodes of cyclosporiasis/year and 0.22 episodes of cryptosporidiosis/year of follow-up. The incidence of cryptosporidiosis peaked at 0.42 for 1-year-old children and declined to 0.06 episodes/child-year for 5- to 9-year-old children. In contrast, the incidence of cyclosporiasis was fairly constant among 1- to 9-year-old children (0.21 to 0.28 episodes/child-year). Likelihood of diarrhea decreased significantly with each episode of cyclosporiasis; for cryptosporidiosis, this trend was not statistically significant. Both infections were more frequent during the warm season (December to May) than the cooler season (June to November). Cryptosporidiosis was more frequent in children from houses without a latrine or toilet. Cyclosporiasis was associated with ownership of domestic animals, especially birds, guinea pigs, and rabbits

A Statistical Analysis of the SOT-Hinode Observations of Solar Spicules and their Wave-like Behavior

We consider a first important parameter of spicules as observed above the solar visible limb: their apparent diameter as a function of the height above the limb which determines their aspect ratio and leads to the discussion of their magnetic origin using the flux tube approximation. We found that indeed spicules show a whole range of diameters, including unresolved "interacting spicules" (I-S), depending of the definition chosen to characterize this ubiquitous dynamical phenomenon occurring into a low coronal surrounding. 1-D Fourier amplitude spectra (AS) made at different heights above the limb are shown for the first time. A definite signature in the 0.18 to 0.25 Mm range exists, corresponding to the occurrence of the newly discovered type II spicules and, even more impressively, large Fourier amplitudes are observed in the 0.3 to the 1.2 Mm range of diameters and spacing, in rough agreement with what historical works were reporting. Additionally, some statistically significant behavior, based on AS computed for different heights above the limb, is discussed. "Time slice or x-t diagrams" revealing the dynamical behavior of spicules are also analyzed. They show that most of spicules have multiple structures (similarly to the doublet spicules) and they show impressive transverse periodic fluctuations which were interpreted as upward kink or Alfven waves. Evidence of the helical motion in spicules is now well evidenced, the typical periods of the apparent oscillation being around 120 sec. A fine analysis of the time-slice diagram as a function of the effective heights shows an interesting new feature near the 2 Mm height. We speculate on the interpretation of this feature as being a result of the dynamical specificities of the spicule helical motion as seen in these unprecedented high resolution HCaII line emission time series.Comment: 21 pages, 8 figurs, 1 tabl

Reducing variability in the cost of energy of ocean energy arrays

Variability in the predicted cost of energy of an ocean energy converter array is more substantial than for other forms of energy generation, due to the combined stochastic action of weather conditions and failures. If the variability is great enough, then this may influence future financial decisions. This paper provides the unique contribution of quantifying variability in the predicted cost of energy and introduces a framework for investigating reduction of variability through investment in components. Following review of existing methodologies for parametric analysis of ocean energy array design, the development of the DTOcean software tool is presented. DTOcean can quantify variability by simulating the design, deployment and operation of arrays with higher complexity than previous models, designing sub-systems at component level. A case study of a theoretical floating wave energy converter array is used to demonstrate that the variability in levelised cost of energy (LCOE) can be greatest for the smallest arrays and that investment in improved component reliability can reduce both the variability and most likely value of LCOE. A hypothetical study of improved electrical cables and connectors shows reductions in LCOE up to 2.51% and reductions in the variability of LCOE of over 50%; these minima occur for different combinations of components.The research leading to this publication is part of the DTOceanPlus project which has received funding from the EuropeanUnion's Horizon 2020 research and innovation programme under grant agreement No 785921. Funding was also received from the European Community's Seventh Framework Programme for the DTOcean Project (grant agreement No. 608597). The contribution of Sandia National Laboratories was funded by the U.S. Department of Energy's Water Power Technologies Office. Sandia National Laboratories is a multi-mission laboratory managed and operated by National Technology and Engineering Solutions of Sandia, LLC., a wholly owned subsidiary of Honeywell International, Inc., for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-NA0003525. This paper describes objective technical results and analysis. Any subjective views or opinions that might be expressed in the paper do not necessarily represent the views of the U.S. Department of Energy or the United States Government. The image of the RM3 device, in Fig. 7, was reproduced with the permission of Sandia National Laboratorie

Observation of kink waves in solar spicules

Height series of H${\alpha}$ spectra in solar limb spicules obtained with the 53 cm coronagraph of the Abastumani Astrophysical Observatory are analyzed. Each height series covered 8 different heights beginning at 3800 km above the photosphere. The spatial difference between neighboring heights was 1$^{\prime \prime}$, consequently $\sim$ 3800 - 8700 km distance above the photosphere has been covered. The total time duration of each height series was 7 s. We found that nearly 20% of measured height series show a periodic spatial distribution of Doppler velocities. We suggest that this spatial periodicity in Doppler velocity is caused by propagating kink waves in spicules. The wave length is found to be $\sim$ 3500 km. However the wave length tends to be $\sim$ 1000 km at the photosphere due to the height variation of the kink speed. This probably indicates to a granular origin for the waves. The period of waves is estimated to be in the range of 35-70 s. These waves may carry photospheric energy into the corona, therefore can be of importance in coronal heating.Comment: 4 pages, 4 figures, Accepted in A&

Numerical Simulations of Magnetoacoustic-Gravity Waves in the Solar Atmosphere

We investigate the excitation of magnetoacoustic-gravity waves generated from localized pulses in the gas pressure as well as in vertical component of velocity. These pulses are initially launched at the top of the solar photosphere that is permeated by a weak magnetic field. We investigate three different configurations of the background magnetic field lines: horizontal, vertical and oblique to the gravitational force. We numerically model magnetoacoustic-gravity waves by implementing a realistic (VAL-C) model of solar temperature. We solve two-dimensional ideal magnetohydrodynamic equations numerically with the use of the FLASH code to simulate the dynamics of the lower solar atmosphere. The initial pulses result in shocks at higher altitudes. Our numerical simulations reveal that a small-amplitude initial pulse can produce magnetoacoustic-gravity waves, which are later reflected from the transition region due to the large temperature gradient. The atmospheric cavities in the lower solar atmosphere are found to be the ideal places that may act as a resonator for various oscillations, including their trapping and leakage into the higher atmosphere. Our numerical simulations successfully model the excitation of such wave modes, their reflection and trapping, as well as the associated plasma dynamics

Observations of quasi-periodic phenomena associated with a large blowout solar jet

A variety of periodic phenomena have been observed in conjunction with large solar jets. We aim to find further evidence for {(quasi-)}periodic behaviour in solar jets and determine what the periodic behaviour can tell us about the excitation mechanism and formation process of the large solar jet. Using the 304 {\AA} (He-II), 171 {\AA} (Fe IX), 193 {\AA} (Fe XII/XXIV) and 131 {\AA} (Fe VIII/XXI) filters on-board the Solar Dynamic Observatory (SDO) Atmospheric Imaging Assembly (AIA), we investigate the intensity oscillations associated with a solar jet. Evidence is provided for multiple magnetic reconnection events occurring between a pre-twisted, closed field and open field lines. Components of the jet are seen in multiple SDO/AIA filters covering a wide range of temperatures, suggesting the jet can be classified as a blowout jet. Two bright, elongated features are observed to be co-spatial with the large jet, appearing at the jet's footpoints. Investigation of these features reveal they are defined by multiple plasma ejections. The ejecta display (quasi-)periodic behaviour on timescales of 50 s and have rise velocities of 40-150 km\,s$^{-1}$ along the open field lines. Due to the suggestion that the large jet is reconnection-driven and the observed properties of the ejecta, we further propose that these ejecta events are similar to type-II spicules. The bright features also display (quasi)-periodic intensity perturbations on the timescale of 300 s. Possible explanations for the existence of the (quasi-)periodic perturbations in terms of jet dynamics and the response of the transition region are discussed.Comment: Astronomy and Astrophysics - In Prin