Implementation of Post Falls Huddles in Skilled Nursing Facility

The purpose of this paper is to discuss the quality improvement project, implementation of the post fall huddle in a long-term care facility. Falls are the most common problem in adults 65 years and older. Falls in this population can have devastating effects, often leading to significant changes in morbidity or death. Adults in long term care settings have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion (CDC, 2015). At the skilled facility, there has been a significant increase in hospitalizations due to injuries sustained from falls. To address this problem, the literature recommends and supports the practice of a post-fall huddle to discuss and drill down the root cause of the falls. Most of the literature written today is about utilizing post fall huddles in Hospital settings. There is limited clinical practice data that addresses the implementation of post fall huddles in long term care settings and its effects on reducing falls. Based on the literature review recommendations and the needs of the facility, a quality improvement project was implemented. The results of the project were analyzed to show if the post-fall huddle reduced the number of recurrent patient falls and reduce the number of falls within the facility in the eight-week time frame. The analyzed results showed a significant decrease in falls therefore decreasing the number of hospitalizations due to fall related injuries

Influence of prior activity (warm-up) and inspiratory muscle training upon between- and within-day reliability of maximal inspiratory pressure measurement

This is the post-print version of the article. The official published version can be obtained from the link below.BACKGROUND: A specific inspiratory muscle ‘warm-up’ (IWU) prior to assessment of maximal inspiratory mouth pressure (PImax) may reduce the number of measurements required to obtain reproducible, representative estimates of PImax. The influence of inspiratory muscle training (IMT) upon this phenomenon is unknown. OBJECTIVE: Compare the impact of an IWU on the between- and within-day reliability of PImax before and after IMT. METHOD: Eight participants were assessed on 4 separate occasions: 2 trials preceded IMT and 2 followed it. At each assessment, the highest of 3 initial efforts was recorded as the pre-IWU value (PI). The highest of 9 subsequent efforts that followed 2 sets of 30 breaths at 40% PI was recorded as PImax. Following 4 weeks of IMT, the trials were repeated. RESULTS: IWU increased PI by 11–17% (p ≤ 0.01), irrespective of IMT status. After IWU, 5–6 efforts were required to determine PImax, irrespective of IMT status. PImax was similar between the 2 trials before IMT and the 2 trials after IMT (p ≥ 0.05), and was 21% higher after IMT (p ≤ 0.01). The coefficient of variation was excellent before and after IWU, both before (1.9 and 0.6%, respectively) and after IMT (1.1 and 0.3%, respectively). Limits of agreement and sample sizes for effect sizes ≤10% were substantially smaller after IWU in all trials. CONCLUSIONS: (1) IWU enhances the between-day reliability of PImax measurement, and this is unaffected by IMT, and (2) judgements regarding acceptability in relation to PImax reliability should be made in relation to analytical goals and we present data to facilitate this

Are the majority of Sun-like stars single?

It has recently been suggested that, in the field, $\sim\!\!56\%$ of Sun-like stars ($0.8\,{\rm M}_{_\odot}\lesssim M_\star\lesssim 1.2\,{\rm M}_{_\odot}$) are single. We argue here that this suggestion may be incorrect, since it appears to be based on the multiplicity frequency of systems with Sun-like primaries, and therefore takes no account of Sun-like stars that are secondary (or higher-order) components in multiple systems. When these components are included in the reckoning, it seems likely that only $\sim\!46\%$ of Sun-like stars are single. This estimate is based on a model in which the system mass function has the form proposed by Chabrier, with a power-law Salpeter extension to high masses; there is a flat distribution of mass ratios; and the probability that a system of mass $M$ is a binary is $\,0.50 + 0.46\log_{_{10}}\!\left(M/{\rm M}_{_\odot}\right)\,$ for $\,0.08\,{\rm M}_{_\odot}\leq M\leq 12.5\,{\rm M}_{_\odot}$, $\,0\,$ for $\,M<0.08\,{\rm M}_{_\odot}$, and $\,1\,$ for $\,M>12.5\,{\rm M}_{_\odot}$. The constants in this last relation are chosen so that the model also reproduces the observed variation of multiplicity frequency with primary mass. However, the more qualitative conclusion, that a minority of Sun-like stars are single, holds up for virtually all reasonable values of the model parameters. Parenthetically, it is still likely that the majority of {\it all} stars in the field are single, but that is because most M Dwarfs probably are single.Comment: 6 pages. Accepted by MNRA

Value-Added Modeling for Teacher Effectiveness

[Excerpt] This report addresses issues associated with the evaluation of teacher effectiveness based on student growth in achievement. It focuses specifically on a method of evaluation referred to as value-added modeling (VAM). Although there are other methods for assessing teacher effectiveness, in the last decade, VAM has garnered increasing attention in education research and policy due to its promise as a more objective method of evaluation. The first section of this report describes what constitutes a VAM approach and how it estimates the so-called “teacher effect.” The second section identifies the components necessary to conduct VAM in education settings. Third, the report discusses current applications of VAM at the state and school district levels and what the research on these applications says about this method of evaluation. The fourth section of the report explains some of the implications these applications have for large-scale implementation of VAM. Finally, the report describes some of the federal policy options that might arise as Congress considers legislative action around these or related issues

Hypocenter estimation for 14 earthquakes in south-central Alaska (1929-1975)

We provide results from an analysis of 14 historical earthquakes in the region of Cook Inlet and Susitna, south-central Alaska. Using global arrival times of P and S waves, we estimate probabilistic hypocenters using the code NonLinLoc. We provide the complete results, as well as a set of plots to help interpret the likelihood of each earthquake being within the crust, on the subduction interface, or within the subducting Pacific slab.V. Silwal and C. Tape were supported by USGS Earthquake Hazards Program (contract G15AP00052)