Sustainability of a DNP QI project on BMI screening and weight management documentation in Primary Care

Background: Nurses with a Doctor of Nursing (DNP) degree are prepared at the highest level of expertise to provide safe and efficient health care to patients and help bridge the gap between research and evidence-based health care. Although DNP students invest significant effort, time and resources to implement quality improvement (QI) projects, the sustainability of the outcomes of these is not well studied and empirical evidence on sustainability of quality improvement interventions is very limited. Objective: To assess the sustainability of the QI project titled: “Using Rapid Cycle Improvement to Improve Weight Management” over time and evaluate the characteristics of the clinic associated with the sustainability of the QI project. Methods: This is a single-center, descriptive study to assess the sustainability of the QI project at a Family Medicine and Community Clinic in 2018. To examine the rates of intervention sustainability, data was obtained from the EHR for all patients seen at the clinic in November 2020. Additionally, qualitative data was collected through staff surveys to identify the contextual factors associated with the sustainability of the QI project using the Practical Robust Implementation and Sustainability Model (PRISM) framework as a guide. Results: Quantitative data showed that BMI screening and weight management documentation was 30.0 % (2019) and 30.8% (2020) which is lower compared to the rates at the end of the QI project in 2018 (33.89%) and the goal of 65% for reimbursement purposes. Although the rates remain low, the practice of BMI screening and weight management is sustained at this setting. Multiple factors including importance of practice, knowledge of intervention and administrative support were identified as facilitator by nursing staff, while time constraint was the main barrier identified by providers to complete weight management documentation. Conclusion: Study findings indicate that although BMI screening and weight management documentation is sustained at a Family Medicine and Community Clinic, the initial implementation efforts of increasing the rates of this intervention by the previous DNP project are not reached. Associated contextual factors identified by this study should be considered by the clinic leaders and future researchers to implement further interventions to improve the rate of BMI screening and weight management documentation in this setting

Numerical and Analytical Modeling of Aligned Short Fiber Composites including Imperfect Interfaces

Finite element calculations were used to bound the modulus of aligned, short-fiber composites with randomly arranged fibers, including high fiber to matrix modulus ratios and high fiber aspect ratios. The bounds were narrow for low modulus ratio, but far apart for high ratio. These numerical experiments were used to evaluate prior numerical and analytical methods for modeling short-fiber composites. Prior numerical methods based on periodic boundary conditions were revealed as acceptable for low modulus ratio, but degenerate to lower bound modulus at high ratio. Numerical experiments were also compared to an Eshelby analysis and to an new, enhanced shear lag model. Both models could predict modulus for low modulus ratio, but also degenerated to lower bound modulus at high ratio. The new shear lag model accounts for stress transfer on fiber ends and includes imperfect interface effects; it was confirmed as accurate by comparison to finite element calculations.Keywords: Elasticity, Finite element analysis (FEA), Elastic properties, Interface/interphase, Discontinuous reinforcement, Short-fiber compositesKeywords: Elasticity, Finite element analysis (FEA), Elastic properties, Interface/interphase, Discontinuous reinforcement, Short-fiber composite

The Effect of Authentic Problem-Based Vocabulary Tasks on Vocabulary Learning of EFL Learners

Language learners’ cognitive engagement with the content in language classes has been advocated in the last few decades (Laufer & Hulstjin, 2001). To this end, the researcher designed authentic problem-based tasks which make use of learners’ cognitive and metacognitive skills to solve real-life vocabulary tasks. Nelson vocabulary test was administered to 64 Iranian EFL learners studying at a language institute in Tehran. By considering 1 standard deviation above and below the mean score, two cohorts of participants were selected for this study, i.e., the experimental group (n=24) and the control group (n=23). Conventional vocabulary learning tasks were implemented in the control group classes for 10 sessions while authentic problem-based vocabulary learning tasks were implemented in experimental group classes.  The results of data analysis revealed that the experimental group participants outperformed the control group learners in both tests of vocabulary recall and vocabulary retention (administered after a two-week interval). Pedagogical Implications are discussed

Application of Turbo-Codes in Digital Communications

This thesis aims at providing results and insight towards the application of turbo-codes in digital communication systems, mainly in three parts. The first part considers systems of combined turbo-code and modulation. This section follows the pragmatic approach of the first proposed such system. It is shown that by optimizing the labeling method and/or modifying the puncturing pattern, improvements of more than 0. 5 dB insignal to noise ratio (SNR) are achieved at no extra cost of energy, complexity, or delay. Conventional turbo-codes with binary signaling divide the bit energy equally among the transmitted turbo-encoder output bits. The second part of this thesis proposes a turbo-code scheme with unequal power allocation to the encoder output bits. It is shown, both theoretically and by simulation, that by optimizing the power allocated to the systematic and parity check bits, improvements of around 0. 5 dB can be achieved over the conventional turbo-coding scheme. The third part of this thesis tackles the question of ``the sensitivity of the turbo-code performance towards the choice of the interleaver'', which was brought up since the early studies of these codes. This is the first theoretical approach taken towards this subject. The variance of the bound is evaluated. It is proven that the ratio of the standard deviation over the mean of the bound is asymptotically constant (for large interleaverlength, N), decreases with N, and increases with SNR. The distribution of the bound is also computationally developed. It is shown that as SNR increases, a very low percentage of the interleavers deviate quite significantly from the average bound but the majority of the random interleavers result in performances very close to the average. The contributions of input words of different weights in the variance of performance bound are also evaluated. Results show that these contributions vary significantly with SNR and N. These observations are important when developing interleaver design algorithms

Assessment of Intra- and Inter-examiner Reproducibility of Probing Depth Measurements with a Manual Periodontal Probe

<p><strong>Background and aims.</strong> The main purpose of this study was to assess intra- and inter-examiner reproducibility of probing depth measurements with a manual periodontal probe. </p><p><strong>Materials and methods.</strong> In this study, 32 dental students in Tabriz Faculty of Dentistry with normal periodontium were evaluated. Each tooth of the upper right quadrants, except the third molars, was examined. Probing depths were measured in 6 surfaces of each tooth (mesiofacial, midfacial, distofacial, mesiolingual, midlingual and distolingual). Each patient was examined by two examiners (two periodontists) in two sessions with an interval of 7-10 days. A total of 218 teeth and 1295 surfaces were examined. </p><p><strong>Results.</strong> Intra-examiner measurements showed no statistically significant differences, while the differences of inter-examiner measurements were statistically significant. Intra-examiner reproducibility was more than the inter-examiner one. Measurements for anterior region, facial and mid-facial/mid-lingual surfaces were more reproducible than posterior, lingual and proximal surfaces. </p><p><strong>Conclusion.</strong> Probing depth measurements with a conventional probe have an appropriate reproducibility in clinical settings, although variations between examiners may affect the reproducibility, especially when great accuracy is required.</p&gt

Emotional Regulation Training, internet addiction disorder, and the Moderating Role of Brain-Behavioral Systems: Examination and analysis

The purpose of the current study was to examine the efficacy of emotional regulation training on Internet addiction disorder with the moderating role of brain-behavioral systems. The current research is a quasi-experimental study that employs with a pre-test/post-test design with a control group and a follow-up period for its purposes. The statistical population of the research were Internet using students of the second educational level in Islamshahr in the second half of 2021(15-20 years old girls). The research participants were selected using a convenience purposive sampling and were then randomly assigned to three experimental groups (45 people) and three control groups (45 people). Revised Reinforcement Sensitivity Theory Questionnaire (r-RST), Internet Addiction Inventory and Emotional Regulation Training scale were used to collect the data, which were then analyzed using SPSS v. 22. Findings: The findings indicated that emotional regulation training can significantly alleviate Internet addiction in three groups of behavioral activation system, brain inhibition and fight-flight-or-freeze response systems. Conclusion: The results of the study support the notion of using emotional regulation training to reduce internet addiction disorder in students

Analysis of structural equations in relation to marital conflicts and emotional security with perceived stress and pregnancy worries mediated by psychological well-being in pregnant women

Background: Pregnancy is one of the most important events in a womanchr('39')s life. Although for most women it is a pleasant period, it is often considered stressful, involving physiological and psychological changes, so that the occurrence of a series of discomforts and problems can have significant effects on pregnant women’s mental state. Aims: The aim of this study was to determine the fit of the model of the relationship between marital conflict and Emotional security with perceived stress and Pregnancy worries and through the mediation of psychological Well-being in pregnant women. Method: The research method was descriptive-correlational and the statistical population of this study included pregnant women referring to gynecology and obstetrics clinics and Ramsar city hospital in the period of February 2017 to April 2017. 384 people were selected as a sample using simple random sampling method. Data Collection included Tools Questionnaire, Psychological Well-being Scale, Pregnancy worries Questionnaire, Perceived Stress Questionnaire and Revised Emotional security test .Data analysis was performed using structural equation modeling. The study of this findings show that there is a relation between marital conflict and perceived stress mediated by psychological Well-being in pregnant women. Results: There is relationship between marital conflicts and pregnancy worries with the mediation of psychological Well-being in pregnant women. There was no relationship between marital conflicts and biological characteristics mediated by psychological Well-being in pregnant women. There is relationship between emotional secure, perceived stress and pregnancy concerns mediated by psychological Well-being in pregnant women. (P Conclusions: Marital conflicts and Emotional security through predictive psychological Well-being play a predictive role on perceived stress and pregnancy concerns in pregnant women. </p

Optimizing dynamic economic dispatch through an enhanced Cheetah-inspired algorithm for integrated renewable energy and demand-side management

Abstract This study presents the Enhanced Cheetah Optimizer Algorithm (ECOA) designed to tackle the intricate real-world challenges of dynamic economic dispatch (DED). These complexities encompass demand-side management (DSM), integration of non-conventional energy sources, and the utilization of pumped-storage hydroelectric units. Acknowledging the variability of solar and wind energy sources and the existence of a pumped-storage hydroelectric system, this study integrates a solar-wind-thermal energy system. The DSM program not only enhances power grid security but also lowers operational costs. The research addresses the DED problem with and without DSM implementation to analyze its impact. Demonstrating effectiveness on two test systems, the suggested method's efficacy is showcased. The recommended method's simulation results have been compared to those obtained using Cheetah Optimizer Algorithm (COA) and Grey Wolf Optimizer. The optimization results indicate that, for both the 10-unit and 20-unit systems, the proposed ECOA algorithm achieves savings of 0.24% and 0.43%, respectively, in operation costs when Dynamic Economic Dispatch is conducted with Demand-Side Management (DSM). This underscores the advantageous capability of DSM in minimizing costs and enhancing the economic efficiency of the power systems. Our ECOA has greater adaptability and reliability, making it a promising solution for addressing multi-objective energy management difficulties within microgrids, particularly when demand response mechanisms are incorporated. Furthermore, the suggested ECOA has the ability to elucidate the multi-objective dynamic optimal power flow problem in IEEE standard test systems, particularly when electric vehicles and renewable energy sources are integrated

Extendable high gain low current/high pulse modified quadratic–SEPIC converter for water treatment applications

Abstract Substantial attention has been drawn over the past few years by high step-up dc-dc converters owing to their applications in a wide range. Apart from renewable energy applications, high voltage/ high pulse converters are efficiently used in water treatment applications. The converter suggested a combination of Quadratic and SEPIC converters with a diode-capacitor cell. This topology generates high-voltage repetitive pulses with a single semiconductor switch and reduced component count. The stress across the components is less than the high-gain converters reported in the literature. The topology has an extendable feature by increasing the number of diode-capacitor cells without affecting the stress. The superiority of the high pulse generating topology is validated with a similar converter in the literature. This paper discusses the nL5 simulator results for the proposed rated topology required for water treatment. A scaled-down 50 W prototype is tested for various input voltages to generate high voltage pulse, and the analytical study is validated