Heart Failure Management in a Skilled Nursing Facility

Background: Reducing heart failure hospital readmissions remains a priority for health systems and is a marker of quality for the Center for Medicare and Medicaid Services (CMS). Heart Failure is the most common cause of U.S. hospital admissions and an effective management program in the nursing home setting is crucial for quality and outcomes. Purpose: The purpose of this project was to implement and evaluate a Nurse Practitioner/Physician supported heart failure management program in a skilled nursing facility that is able to be incorporated into facility staff workflow, enhances nursing staff knowledge of heart failure, improves identification of patients with a heart failure diagnosis, and reduces facility hospitalization rates over a three-month period of time. Methods: This was an evidence informed practice implementation and evaluation project that focused on all patients with a diagnosis of heart failure in a suburban skilled nursing facility. Quantitative data was obtained by using the Nurses Knowledge of Heart Failure survey and rehospitalization data was obtained from the practice site. Results: Eighteen patients were followed by the program. All had timely identification,16.66% experienced a change of condition that triggered medical provider follow up and none had a heart failure related hospitalization. Six nursing staff completed the pretest (mean, [SD], 78.33, [13.29]) and posttest (86.66, [10.80]) and demonstrated a positive relationship between program implementation and nurses’ knowledge. Conclusion: Implementation of a heart failure management program is associated with timely identification of patients, improved nursing knowledge, and timely intervention during changes in condition

Mechatronic Camera Operator: Final Design Report

A mechatronic system is designed, constructed, and tested to aid filmmakers in the movement and control of a video camera. The system design allows for 6-DOF camera movement (movement in all three spatial directions, pan, tilt, and roll). The system is controlled by a human operator, using an implementation of a gamepad controller, and the system is battery-powered; the theoretical range of the system is therefore limited only by the onboard battery power, and the operator’s ability to keep within cord-length of the system as it moves. A misallocation of time resources resulted in an incomplete physical design, but preliminary testing indicates that the design is sound, and that mechanical specifications are sufficiently robust for a working final system. Further time and resources would be used to complete physical construction and electronic implementation, and to implement a feedback system to allow for closed-loop actuator control and the function of repeatable motio

Waste Not, Want Not: Analyzing the Economic and Environmental Viability of Waste-to-Energy (WTE) Technology for Site-Specific Optimization of Renewable Energy Options

Waste-to-energy (WTE) technology burns municipal solid waste (MSW) in an environmentally safe combustion system to generate electricity, provide district heat, and reduce the need for landfill disposal. While this technology has gained acceptance in Europe, it has yet to be commonly recognized as an option in the United States. Section 1 of this report provides an overview of WTE as a renewable energy technology and describes a high-level model developed to assess the feasibility of WTE at a site. Section 2 reviews results from previous life cycle assessment (LCA) studies of WTE, and then uses an LCA inventory tool to perform a screening-level analysis of cost, net energy production, greenhouse gas (GHG) emissions, and conventional air pollution impacts of WTE for residual MSW in Boulder, Colorado. Section 3 of this report describes the federal regulations that govern the permitting, monitoring, and operating practices of MSW combustors and provides emissions limits for WTE projects

Air entrainment through free-surface cusps

In many industrial processes, such as pouring a liquid or coating a rotating cylinder, air bubbles are entrapped inside the liquid. We propose a novel mechanism for this phenomenon, based on the instability of cusp singularities that generically form on free surfaces. The air being drawn into the narrow space inside the cusp destroys its stationary shape when the walls of the cusp come too close. Instead, a sheet emanates from the cusp's tip, through which air is entrained. Our analytical theory of this instability is confirmed by experimental observation and quantitative comparison with numerical simulations of the flow equations

Linked trends in the South Pacific sea ice edge and Southern Oscillation Index

Previous work have shown that sea ice variability in the South Pacific is associated with extratropical atmospheric anomalies linked to the Southern Oscillation (SO). Over a 32 year period (1982–2013), our study shows that the trend in Southern Oscillation Index (SOI) is also able to quantitatively explain the trends in sea ice edge, drift, and surface winds in this region. On average two thirds of the winter ice edge trend in this sector, linked to ice drift and surface winds, could be explained by the positive SOI trend, thus subjecting the ice edge to strong decadal SO variability. If this relationship holds, the negative SOI trend prior to the recent satellite era suggests that ice edge trends opposite to that of the recent record over a similar time scale. Significant low-frequency ice edge trends, linked to the natural variability of SO, are superimposed upon any trends expected of anthropogenic forcing

Adaptation-Based Programming in Haskell

We present an embedded DSL to support adaptation-based programming (ABP) in Haskell. ABP is an abstract model for defining adaptive values, called adaptives, which adapt in response to some associated feedback. We show how our design choices in Haskell motivate higher-level combinators and constructs and help us derive more complicated compositional adaptives. We also show an important specialization of ABP is in support of reinforcement learning constructs, which optimize adaptive values based on a programmer-specified objective function. This permits ABP users to easily define adaptive values that express uncertainty anywhere in their programs. Over repeated executions, these adaptive values adjust to more efficient ones and enable the user's programs to self optimize. The design of our DSL depends significantly on the use of type classes. We will illustrate, along with presenting our DSL, how the use of type classes can support the gradual evolution of DSLs.Comment: In Proceedings DSL 2011, arXiv:1109.032