Association of language concordance and restraint use in adults receiving mechanical ventilation

PURPOSEClinician-patient language concordance improves patient outcomes in non-intensive care unit (ICU) settings. We sought to assess the association of ICU nurse-patient language concordance with delirium-related outcomes. METHODSWe conducted a retrospective cohort study of adult English- or Spanish-speaking mechanically ventilated ICU patients admitted to ICUs at the University of Miami Hospital and Clinics (January 2021-September 2022). Our primary exposure was nurse-patient language concordance on each shift. We used mixed-effects multivariable regression to evaluate the association of language concordance with the primary outcome of restraint use, and secondary outcomes of agitation and identification of delirium, during each shift (with patient as a random effect). RESULTSOur cohort included 4326 shifts (3380 [78.1%] with language concordance) from 548 patients and 157 nurses. Spanish language was preferred by 269 (49.1%) of patients. English-speaking patients tended to be younger (65 [53, 75] vs 73 [61, 83], p < 0.001) and of non-Hispanic ethnicity (55.5% vs 7.1%, p < 0.001). English-speakers had restraints ordered on fewer of their included shifts (0 [0, 3] vs 1 [0, 3], p = 0.005). After adjustment, the odds of restraint use on shifts with language concordance was significantly lower (odds ratio [OR, 95% confidence interval [CI]]: 0.50 [0.39-0.63], p < 0.001). Agitation (18.6% vs 25.2%; OR [95% CI]: 0.71 [0.55-0.92], p = 0.009) and delirium identification (34.5% vs 41.3%; OR [95% CI]: 0.54 [0.34-0.88], p = 0.014) were also less common. CONCLUSIONSWe identified a twofold reduction in the odds of restraint use among mechanically ventilated patients for language concordant nurse-patient dyads. Ensuring nurse-patient language concordance may improve ICU delirium, agitation, and restraint use

Use of Multi-Level Wells in Developing a 3-Dimensional Understanding of Groundwater Flow and Contaminant Migration at the Savannah River Site

Understanding the flow of groundwater and contaminants in 3-dimensions, along with hydraulic properties, is instrumental in selection and implementation of successful remediation efforts. Advances in multi-level groundwater monitoring at the Savannah River Site (SRS) are enabling engineers and geologists to collect the needed characterization data in an efficient, cost-effective manner. The SRS has developed a new multi-level groundwater monitoring well, �StrataSampler�, which is being deployed for characterization and monitoring at several large groundwater plumes on the SRS. The installation method used allowed collection of data during the drilling process allowing optimization of screen placement within the aquifers and minimization of drilling costs and waste generation. Data generated during the installation of the StrataSamplers along with data collected from the installed wells is being used to understand the 3-dimensional nature of contaminant fate and transport. The L-Area Southern Groundwater Operable Unit is the first full-scale deployment of StrataSampler wells at SRS. Twenty-two StrataSampler wells with a total of 52 sampling zones were installed. The installation, development, hydraulic testing, sampling of the StrataSamplers at this unit and the resulting understanding of the contaminant plumes will be discussed in the paper and presentation

The Implementation of Participatory Democracy in French Communes

The purpose of the article is to analyze how participatory democracy has been implemented in French communes. The question of neighbourhood democracy is a norm of political speech as local representatives need to legitimize their role in public space by getting closer to their electors. Does the implementation of participatory tools depend on the ideology and the socialization of the mayors or on the structure of the commune (size, territorial configuration)?The paper will mainly use a quantitative investigation made on communes above 5 000 inhabitants as well as interviews conducted in specific communes which were known for their participatory culture