Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure

BACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. OBJECTIVE: The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. METHODS: We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. RESULTS: We identified 5 high-level macrocognitive processes affecting medication management-sensemaking, planning, coordination, monitoring, and decision making-and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. CONCLUSIONS: Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation

A CASE STUDY ON TEACHER PERCEPTIONS OF THE WISCONSIN STATE EDUCATOR EFFECTIVENESS REQUIREMENT: MANDATES AND RESULTS

Teachers are the essential element in improving student learning in education. The State of Wisconsin requires public school teachers to participate in the Wisconsin Educator Effectiveness System. There is limited research on the links between required participation with the State of Wisconsin’s Educator Effectiveness System and on the experience of teachers and their outcomes for students (Dvorak et al., 2014; Jones, 2017). This qualitative case study explored, through semi-structured interviews, the experiences of Wisconsin educators who engaged with the EE System, teachers’ connections with EE and subsequent changes to their practice. The study addressed whether teachers’ felt the technical elements required within the EE System and the related professional development they experienced contributed to changes in their teaching practice and perceptions of improvements in learning outcomes. Findings suggest that this governmental mandate has not fully led to the results envisioned, and the unintended consequences are many and the unanticipated results have had a cumulative effect on the educators who participated in this study. Teacher experiences were positive, negative, endemic and often uncertain. This study concludes with recommendations for the Educator Effectiveness System today and for the future

Das Berufsbild „Orchestermusiker_in“ – Kulturpolitische Betrachtungen der Entwicklung künstlerischer Ausbildung in Deutschland von 1930 bis heute

Der Beruf Orchestermusiker_in ist seit einigen Jahrzehnten in der Mitte der Gesellschaft angekommen. Festanstellungen und soziale Absicherungen unterstreichen die Gleichwertigkeit mit anderen Berufsständen, das hohe Ansehen gründet jenseits der Adoration ihrer performativen Tätigkeit auch auf dem pädagogischen und gesellschaftlichen Engagement. Ausgehend von der Betrachtung einer engen Verflechtung zwischen Ausbildung, Probespiel und Berufstätigkeit folgt diese Schrift der Forschungsfrage, inwiefern kulturpolitische Entscheidungen im Bildungsbereich und fachspezifische, gesellschaftliche Anforderungen an den Beruf die Entwicklung künstlerischer Ausbildung für Orchesterinstrumente in Deutschland seit 1930 beeinflusst haben. Am Beispiel der Hochschule für Musik und Theater München wird unter Einbindung berufsrelevanter Aspekte der Umgang mit den Wechselwirkungen zwischen den Bereichen veranschaulicht und durch eine systematisierte Darstellung von Lehrstrukturen und -inhalten ergänzt

Acquisition of a Multi-User Thin Film Synthesis and Processing Facility

A state-of-the-art advanced materials synthesis and processing facility focusing on the growth and fabrication of ceramic- based thin film materials will be funded with the assistance of the Academic Research Infrastructure Program. The facility will include a multi-technique thin film materials synthesis chamber equipped with a microwave plasma source, effusion cells, electron beam evaporators, magnetron sputter sources, and a Kauffman ion source. Characterization capabilities will include in-situ reflection high energy electron diffraction (RHEED), mass spectrometry for controlling growth processes, X-ray photoelectron spectroscopy (XPS), and a novel Hall probe for in- situ film characterization. Three major areas of research will be impacted significantly by the facility, namely 1) solid state micro-sensors, 2) nanomechanics of materials, and 3) surfaces and interfaces in hetero-epitaxial oxide systems. In the sensor work, which has connections with local industry, the synthesis and processing of well-defined doped metal-oxide films will be developed with the goal of understanding and controlling the molecular scale mechanisms by which surface microstructure, dopant type, and operating temperature influence sensor performance. A broad based advanced materials synthesis and processing facility for the growth and fabrication of ceramic-based thin films will be operated for the study of solid state microsensors based on metal-oxide ceramic films. The nanomechanics of these ceramic thin films will be studied, as well as the surfaces and interfaces occurring in heteroepitaxial oxide systems

Influence of fluid resuscitation on renal microvascular PO(2 )in a normotensive rat model of endotoxemia

INTRODUCTION: Septic renal failure is often seen in the intensive care unit but its pathogenesis is only partly understood. This study, performed in a normotensive rat model of endotoxemia, tests the hypotheses that endotoxemia impairs renal microvascular PO(2 )(μPO(2)) and oxygen consumption (VO(2,ren)), that endotoxemia is associated with a diminished kidney function, that fluid resuscitation can restore μPO(2), VO(2,ren )and kidney function, and that colloids are more effective than crystalloids. METHODS: Male Wistar rats received a one-hour intravenous infusion of lipopolysaccharide, followed by resuscitation with HES130/0.4 (Voluven(®)), HES200/0.5 (HES-STERIL(® )(® )6%) or Ringer's lactate. The renal μPO(2 )in the cortex and medulla and the renal venous PO(2 )were measured by a recently published phosphorescence lifetime technique. RESULTS: Endotoxemia induced a reduction in renal blood flow and anuria, while the renal μPO(2 )and VO(2,ren )remained relatively unchanged. Resuscitation restored renal blood flow, renal oxygen delivery and kidney function to baseline values, and was associated with oxygen redistribution showing different patterns for the different compounds used. HES200/0.5 and Ringer's lactate increased the VO(2,ren), in contrast to HES130/0.4. CONCLUSION: The loss of kidney function during endotoxemia could not be explained by an oxygen deficiency. Renal oxygen redistribution could for the first time be demonstrated during fluid resuscitation. HES130/0.4 had no influence on the VO(2,ren )and restored renal function with the least increase in the amount of renal work