Implementation of an Early Progressive Mobility Program in the Intensive Care Units

In the United States, adult ICU patient care consumes $90 billion annually, or 1% of the gross national product. In the ICU, about 40% of the patients are mechanically ventilated resulting in an 11% greater length of stay (LOS) that requires 35% more resources. And, an estimated 60% of these patients are adversely impacted for as long as five years following discharge. Patient immobility while ventilated contributes to poor quality and financial outcomes. The Institute of Healthcare Improvement (IHI) reports on average early patient mobility (EPM) reduces a 4.5-day LOS by as much as 1.3 days; and reduces the risk for complications such as ventilator associated pneumonia, thromboembolisms, and pressure ulcers. The purpose of this evidence-based practice (EBP) quality improvement project was to evaluate an EPM program based to improve interdisciplinary collaboration and care coordination. The introduction, development, and evaluation of this project were guided by the Iowa Model and the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) bundle. The EPM program was implemented in a 20-bed ICU in a 400-bed hospital as the Mobilization Criteria / Algorithm for Critical Care Patients (MCACCP). Retrospective data was collected for six months from the electronic health record and evaluated with a web-based analytics tool. The project resulted in a 1.2-day decrease in ICU LOS and a 6.7% reduction in ventilator days. The average daily census decreased from 16.2 in 2015 to 14.7 through 2016. EBP research supports the benefit of early mobility of ICU patients to reduce complications, ventilator days, LOS, and the overall cost for care. This project demonstrates standardizing clinical practice based on EBP guidelines and protocols translates into improved teamwork, patient outcomes, and organization metrics

USING COMMUNITY CULTURAL WEALTH NARRATIVES OF LOW-INCOME HIGH SCHOOL STUDENTS IN A RURAL NORTHERN CALIFORNIA COMMUNITY

This study examined the experiences of white, low-income high school students completing their senior year in a rural community and earning their diplomas. The purpose of the study was to examine participants’ stories during high school using a community cultural wealth framework and narrative methodological approach. Results showed that students utilized capitals such as social, moral, familial and resistant in their small communities. Multiple capitals interacted and influenced each other as rural youth draw on these for support

Cigar City

A young woman disconnected from her roots tries to save her family’s cigar factory from a greedy developer planning to gentrify their Latin neighborhood

¿Qué es un escritor latinoamericano para Roberto Bolaño? Algunas reflexiones a partir de su cuento "argentino"

IX Congresso Brasileiro de Hispanistas realizado nos dias 22 a 25 agosto 2016Al ser preguntado por su nacionalidad, en la entrevista que concedió a Mónica Maristain poco antes de morir, Roberto Bolaño respondió: “soy latinoamericano”. El adjetivo aparece frecuentemente en su obra, lo que muestra la importancia que tenía para este autor que, por lo demás, da la impresión de poder escribir como un mexicano, un chileno o un argentino. La validez de esa impresión, sin embargo, puede ser cuestionada. Verónica Garibotto apunta, por ejemplo, que “El gaucho insufrible no está escrito en rioplatense, sino en “lenguaje Anagrama”. Antes que un defecto, esa falta de autenticidad del lenguaje del cuento puede ser considerada como una elección pertinente dado el tema que aborda: el viaje al Sur de un abogado pensionado de Buenos Aires, en 2001. Un viaje que por ocurrir después del cuento “El Sur” de Borges, en el cual explícitamente se inspira, solo puede ser considerado una farsa, aunque rentable para diferentes agentes como el mercado editorial. Así lo indica el caso del Bebe, el hijo del protagonista, cuya garantía de haberse convertido en un escritor latinoamericano de éxito es haber publicado un libro en España (lo que refleja la historia del propio Bolaño). “El gaucho insufrible” nos servirá para mostrar que ser “latinoamericano” para Bolaño no es nada transparente. Para él, el término está vinculado con una historia de violencia y horror que correspondería al escritor enfrentar con la “lucidez” y “mala leche” que habría tenido Naipaul en su visita a Buenos AiresUNILA­-UNIOEST

Experimental Study of a Cascade of Low Pressure Turbine Blades with Upstream Periodic Stator Wakes

The objective of this study is to experimentally study film cooling flows. A closed-loop wind tunnel with a four passage linear cascade of US Air Force Research Laboratory (AFRL) ultra-high-lift L1A low pressure turbine (LPT) blades and upstream wake generator is used in conjunction with Particle Image Velocimetry (PIV) flow visualization technique to study turbulent film cooling flows due to the interaction between vanes and blades. Further post-processing in the form of Proper Orthogonal Decomposition (POD) and Dynamic Mode Decomposition (DMD) modal analyses is performed to determine the relevant modes that characterize the coherent structures in the flow. An image patching algorithm is also implemented. The results obtained are used to characterize the periodic wake on the cascade flow. The periodic wake has been studied in detail near the leading edge of the suction side. The velocity data led to the mean velocity profile and maximum velocity deficit in the wake. The POD identified the most energetic modes representing the vortex shedding wavelength, and its harmonics, of the wake generator plates. The DMD confirmed the wake passage frequency. Implementation of the image patching algorithm with four domains was presented. The technique was successful in computing the average vector field. Further downstream of the leading edge, the POD modes are shown to become more chaotic and less energetic. The leading order mode pair loses close to half of their energy to lower order modes due to the cascading of turbulent kinetic energy to lower spatial scales and to viscous dissipation losses. When the wake is impinging on the leading edge, the boundary layer separates near the transition point. The boundary layer remains completely attached to the trailing edge when the wake is not impinging on the leading edge

Pert using Fuzzy variables and probability distribution function randomly selected

Program Evaluation and Review Technique (PERT) is widely used for project management in real world applications. The aim of this paper is to simulate and analyze a PERT network under conditions of uncertainty though a hybrid model. The basic assumption is that a project under extreme conditions of uncertainty can be satisfactorily modelled by using simple fuzzy linguistic variables to estimate activities durations, and a probability distribution function randomly selected in order to measure the activity times. Fuzzy linguistic expressions are used to estimate the activity time. Activity parameters are calculated by using basic operations between triangular fuzzy numbers and centroid method with classical Beta PERT definition. For each activity time a probability distribution function is randomly selected from a set of four possible distributions commonly cited in the literature. Hypothetical projects with 4, 40, 400 and 4000 activities using the proposed model are analyzed; the project duration is estimated through Monte Carlo Simulation. Finally, results are analyzed and compared with classical Beta PERT technique

Nudging Online Security Behaviour with Warning Messages: Results from an online experiment

This study is part of a larger effort to better understand online behaviour. We tested the effect on people’s security behaviour of different ways of warning them about cybersecurity threats with an online experiment (n=5,065) in Germany, Sweden, Poland, the UK and Spain. Participants had to make a purchase in a mock online store, and their behaviour was observed through four behavioural measures. Results show that making users aware of the steps they can take to minimise their exposure to risk is effective in generating more secure behaviour, as suggested by protection motivation theory. Gain and loss-framed messages, and a message with a male anthropomorphic character, also had some effect on behaviour compared to the control group. The study also included a questionnaire. Results showed that more risk-averse participants exhibited more cautious behaviour. Finally, although they influenced behaviour itself, warning messages based on behavioural insights did not affect participants' self-reported knowledge of how to prevent cyberattacks.JRC.B.4-Human Capital and Employmen

Testing the Effect of the Cookie Banners on Behaviour

We conducted a laboratory experiment (n=602) to test the effect on behaviour of six different cookie banner messages. These messages were based on four behavioural insights: defaults, information deficit model, protection motivation theory (PMT) and social norms. A control condition presented the traditional cookie banner message as recommended by the European Commission (EC). The behavioural measures were (a) the decision to accept cookies, (b) the decision to click on a link for more information about a website's cookie policy and (c) the time spent reading cookie policy pages. A default banner, which told participants that continuing to browse implied cookie acceptance, led to significantly higher cookie acceptance rates. Participants exposed to a message that included a combination of elements from PMT were less willing to click on a link for more information.JRC.B.4-Human Capital and Employmen