Evaluation of Implementation of a Patient Safety Agreement (PSA) Program on Fall Rates in an Acute Care Hospital

Objective: This study aims to evaluate the impact of implementing a Patient Safety Agreement (PSA) on hospital fall rates. Despite implementation of numerous interventions, patients continue to fall. The PSA program goal is to decrease patient falls in the acute care hospital by engaging patients in their plan of care. Implementing a Patient Safety Agreement program (PSA) can empower patients to become active participants in their own safety and fall prevention measures while in the hospital (Tzeng & Yin, 2014). Many of the current fall prevention intervention program elements employed to reduce patient falls require little active participation from the patient. There is little evidence to show the effectiveness of approaches that engage patients in fall prevention care for reducing fall incidents during hospital stays (Tzeng & Yin, 2014). Prevention of patient falls in the hospital setting has gained an increasing amount of interest over the last decade and is noted as the most frequent adverse event reported in hospitals. The Agency for Healthcare Research and Quality (AHRQ) reports that nearly 1 million patient falls are recorded in U.S. hospitals every year, equating to 2–10% of hospital inpatients falling sometime during their hospital stay (Hefner, Scheck McAlearney, Mansfield, Knupp, & Moffatt- Bruce, 2015). Methods: A pre- and post-evaluation study of a quality improvement initiative in the hospital setting comprised of 11 inpatient care units was conducted to assess the effect of a Patient Safety Agreement (PSA) program on fall rates. Four types of patient care units participated (acute medical and surgical, progressive or intermediate, and critical care areas), in the implementation of the PSA. The National Database of Nursing Quality Indicators (NDNQI) was resourced to ensure a standardized definition and categorization of falls, and uniform method of rate calculation. Patient demographics, LOS, and fall risk scoring were abstracted from the study site’s electronic medical record. The time span for this study will be 1 year to include fall rate pre- and postimplementation. Results: Based on the statistical analysis performed, there was no statistically significant difference in patient falls while in the hospital during the pre- and post-evaluation period. There was no effect realized for patients with a Morse Fall Score (MFS) of 0 on admission. There may be a protective effect, but there is not a statistically significant difference in effect until patient’s have an admission Morse Fall Scale score \u3e 55, at the p \u3c.05 level. Additionally during this study period, there was an increase in falls in patients who had a MFS score between 5 and 45 on admission. Discussion: The anticipated outcome of the PSA is a reduction in patient fall rates. Examination of the patients who experienced a fall while in the hospital setting showed different patterns of fall risk based on mental cognition, length of stay, and medications. Variations in fall risk scores as reported by the Morse Fall Scale were evident. Patient falls were analyzed by fall score and type of fall. Anecdotal findings indicated that the Patient Safety Agreement was generally well accepted by patients, family members/significant others, and staff. Medical Staffs supported the implementation of the PSA process and assisted with reinforcing fall prevention measures. “Patient engagement in their health care could translate into measurable improvements in safety and quality (Tzeng & Yin, 2014)”. Potential limitations to the study include staff adoption of the PSA, language and comprehension barriers, patient cognition, and inconsistent implementation and execution across nursing units

Experimental Investigation of Active Wingtip Vortex Control using Synthetic Jet Actuators

An experiment was performed in the Cal Poly Mechanical Engineering 2x2 ft wind tunnel to quantify the effect of spanwise synthetic jet actuation (SJA) on the drag of a NACA 0015 semispan wing. The wing, which was designed and manufactured for this experiment, has an aspect ratio of 4.20, a span of 0.427 m (16.813”), and is built around an internal array of piezoelectric actuators, which work in series to create a synthetic jet that emanates from the wingtip in the spanwise direction. Direct lift and drag measurements were taken at a Reynolds Number of 100,000 and 200,000 using a load cell/slider mechanism to quantify the effect of actuation on the lift and drag. It was found that the piezoelectric disks used in the synthetic jet actuators cause structural vibrations that have a significant effect on the aerodynamics of the NACA 0015 model. The experiment was performed in a way as to isolate the effect of vibration from the effect of the synthetic jet on the lift and drag. Lift and drag data was supported with pressure readings from 60 pressure ports distributed in rows along the span of the wing. Oil droplet flow visualization was also performed to understand the effect of SJA near the wingtip. The synthetic jet and vibration had effects on the drag. The synthetic jet with vibration decreased the drag only slightly while vibration alone could decrease drag significantly from 11.3% at α = 4° to 23.4% at α = 10° and Re = 100,000. The lift was slightly increased with a slight increase due to the jet and showed a slight increase due to vibration. Two complete rows of pressure ports at 2y/b = 37.5% and 85.1% showed changes in lift due to actuation as well. The synthetic jet increased the lift near the wingtip at 2y/b = 85.1% and had little to no effect inboard at the 37.5% location, hence, the synthetic jet changes the lift distribution on the wing. Oil flow visualization was used to support this claim. Without actuation, the footprint of the tip vortex was present on the upper surface of the wing. With actuation on, the footprint disappeared suggesting the vortex was pushed off the wingtip by the jet. It is possible that the increased lift with actuation can be caused by the vortex being pushed outboard

Posterior Consistency for Missing Data in Variational Autoencoders

We consider the problem of learning Variational Autoencoders (VAEs), i.e., a type of deep generative model, from data with missing values. Such data is omnipresent in real-world applications of machine learning because complete data is often impossible or too costly to obtain. We particularly focus on improving a VAE's amortized posterior inference, i.e., the encoder, which in the case of missing data can be susceptible to learning inconsistent posterior distributions regarding the missingness. To this end, we provide a formal definition of posterior consistency and propose an approach for regularizing an encoder's posterior distribution which promotes this consistency. We observe that the proposed regularization suggests a different training objective than that typically considered in the literature when facing missing values. Furthermore, we empirically demonstrate that our regularization leads to improved performance in missing value settings in terms of reconstruction quality and downstream tasks utilizing uncertainty in the latent space. This improved performance can be observed for many classes of VAEs including VAEs equipped with normalizing flows.Comment: First published in ECML PKDD 2023, Proceedings, Part II, by Springer Nature (https://doi.org/10.1007/978-3-031-43415-0_30). This version of the work has been extended with the addition of an Appendix, which includes proofs, the derivation of the posterior regularization, additional background information on technical topics, an extended related work section, and additional experimental result

Cardiovascular effects of electrolyte imbalance in the golden hamster

Thesis (Ph.D.)--Boston UniversitySince high potassium levels are found in blood concurrently with vasoconstriction, it is important to establish the probable interrelationship. Consequently, cardiovascular effects of potassium and possible mechanisms of action were investigated using the cheek pouch of the golden hamster for direct observation of the microcirculation. The results presented in this dissertation were obtained from two related studies: first, by topical application of solutions containing altered concentrations of ions; and second, by intravenous injection of potassium salts. The vascular pattern of the cheek pouch was investigated and the relationship of structure to functional activity was established as a basis for analysis of comparative effects of solutions with varied salt concentrations. The structural components are arranged in a pattern typical of subcutaneous tissue. The smooth muscle components of the terminal vascular bed are capable of autonomous vasomotor activity, especially in the areas of the vascular sphincters. Vasomotor sensitivity was investigated by topical application of adrenaline chloride and by electrical stimulation of smooth muscle. [TRUNCATED

Evaluation and process of family law and divorce mediation in Polk County, Iowa

Fifty percent of all marriages end in divorce prior to the seventh year of marriage (Bee, 1994; National Center for Health Statistics, 1991). As a result many young children live with one parent. The U.S. Census Bureau (1998) estimates this effects 19.8 million children. Children living in single-headed households are more likely to suffer social, emotional, economic, educational, health and psychological problems (Chase-Lansdale, & Heatherington, 1990; Emery, 1988). Parents also experience difficulties adjusting to the end of a relationship. Amato (1993) believes this transition phase of divorce lasts between 2 to 5 years. Family law/divorce mediation was created to lessen the negative effects of divorce (or the end of a relationship) on parents and their children. In Polk County, Iowa, family law judges began mandating mediation as of January 1, 2000. There were 399 family law cases mediated between February 2000 and January 31, 2001. Of this 798 surveys were provided to participants, 217 surveys were returned. Of the survey respondents, 6 ex-couples and their mediator offered their experiences of family law mediation in Polk County. Eighteen in-depth interviews were conducted to gain a better understanding of how mediators, judges/courts, and attorneys could improve services offered to participants. The findings indicated that a large percentage of participants reported that they would recommend mediation to others, felt mediation was fair, that they were satisfied with and benefited from mediation, and that their mediator did not take sides. All mediations involved custody and visitation issues and other family law issues. Some cases (domestic violence) entering mediation needed to be screened more effectively and waived as the outcomes are typically not favorable. Finally, participants brought up issues concerning when attorneys were to be involved in mediation and how well they felt they prepared them for mediation

Irdhingekujutelm Kihnu memoraatides

The conception of free spirit in memorates from Kihnu island dealing with encountering with the dead. The aim of the current B.A. thesis is to analyze and discuss conceptions of free spirit in the basis of memorates collected from Kihnu during two fieldwork trips in September 2010 and August 2011. Kihnu is a little island in the Gulf of Riga with a rich and living heritage, what is known among the Estonian folklorists as one of the two "cradels" of folklore (the other one is Setumaa). It is known for its cultural and folkloristic naturalness and living folk beliefs. Free spirit is a term from Estonian folklore researcher Oskar Loorits. According to his work the conception of spirit consist a belief in multiple of spirits with their own functions. Free spirit is a spirit that is able to leave one’s physical body in one’s lifetime or after the death. Free spirit can continue one’s independent life in abode of the dead or alive. Nowadays the belief in free spirits is strong in Kihnu island, dead manifest themselves at home, in historic places, in graveyard or around the local school, museum and culture centre. To perceive the attendancy of free spirit one does not need to be in specific state of mind, it can be perceived while sleeping or while everyday situations. Attendancy of the dead is not limited by time - it means that spirits are able to manifest themselves during the whole day. The reasoning for manifesting spirits is believed to be uneasiness of the dead that might be caused by violent death, abjuration of religion or disturbing the peace of the grave. According to Kihnu belief, dead can return home by their own will. Visitant might warn its family before its death that he/she would return home after the death. In Kihnu island free spirits are believed to be all-around dangerous to living people. If a free spirit is visitant, it might scare or even attack living people. Therefore it can be said that free spirits are viable and physical body decreases it strength. Free spirits have greater powers than alive – they are able to change the weather, create spectres etc. Therefore free spirits are dangerous to the people and to the nature. People in Kihnu island use also different magical rites against the dead, but they seem to be not quite effective.http://tartu.ester.ee/record=b2613669~S

Luupainaja sotsiaalne funktsioon Kihnu ühiskonnas: luupainajapärimuse võrdlev analüüs arhiivi- ja välitöömaterjalide põhjal

http://www.ester.ee/record=b450927

Development of Fish Products Technology with Using Food Supplements from Fish Remaining Feedstock

The article describes the technology for the production of chopped fish products from blue whiting with the use of food additives from secondary fish raw materials. The sociological survey results and analysis of Murmansk city population nutritional structure are presented and the main factors that affect the choice of fortified foods are identified. The basic formulation of chopped fish products with the introduction of biologically active mineral components is developed and its optimization is carried out by computer simulation. To search close to optimal for a mineral composition that, taking into account the high organoleptic and rheological characteristics, a high orthogonal rototable by mathematical modeling method. The results were processed Datafit 9.0 computer program by generally accepted statistical methods. The experimental results of the chemical composition of chopped fish products and their caloric value are presented. As a result of the studies, a technological scheme and recipe for chopped fish products from Northern Basin underutilized raw materials such as blue whiting with the secondary fish raw materials additives was developed. Experimentally was obtained, that the using a cutlet portion with the 15% addition from its net weight exceeds the daily share of calcium intake, which is unacceptable due to the presence of other food products containing it in the consumers daily diet. The previously developed optimization recipe for chopped blue whiting products with the fish bones flour addition based on organoleptic and structural-mechanical indicators obtained by mathematical modeling methods allowed us to establish the optimal ratio of the introduced components

Classification cards applied to team and individual learning.

Thesis (Ed.M.)--Boston Universit