A Pilot Evaluation of the Palliative Performance Scale in Long Term Care: Tips for Success

Aims: Palliative care in long-term care (LTC) homes is an area of growing concern. Little work has been done to explore innovative ways to identify and care for residents who become palliative. The purpose of this intervention study was to evaluate the implementation of the Palliative Performance Scale (PPS) in LTC. Specifically we explored staff perceptions about implementing the PPS and how it cued staff to initiate palliative care discussion with residents and family when a resident’s health declined.

Methods: This study utilized a qualitative descriptive design that included data from four separate sources: journals of three ‘champions’ who were responsible for leading the implementation of the PPS; staff evaluations of three educational training sessions; minutes from meetings; and 11 interviews from key staff who were involved in the implementation process. Data were analyzed using thematic content analysis.

Results: Staff generally felt positively about using the PPS in LTC and stated that it increased awareness of palliative care and helped identify those residents who were nearing the end of life. There were some barriers to implementing it, such as staff resistance and lack of time to complete it. The importance of having a designated ‘champion’ and effective interdisciplinary communication in addition to widespread training, were identified as successful strategies to facilitate the implementation process.

Conclusion: These study findings support the use of the PPS in LTC and offer some perspective about ways to implement it successfully. Future work is needed to evaluate the PPS in LTC using more rigorous designs.

Performance Evaluation of Two-Stage Electrokinetic Washing as Soil Remediation Method for Lead Removal using Different Wash Solutions

The study explores the application of a two-stage electrokinetic washing system on remediation of lead (Pb) contaminated soil. The process involved an initial soil washing, followed by an electrokinetic process. The use of electrokinetic process in soil washing not only provided additional driving force for transporting the desorbed Pb away from the soil but also reduced the high usage of wash solution. In this study, the effect of NaNO3, HNO3, citric acid and EDTA as wash solutions on two-stage electrokinetic washing system were evaluated. The results revealed that a two-stage electrokinetic washing process enhanced Pb removal efficiency by 2.52-9.08% and 4.98-20.45% in comparison to a normal electrokinetic process and normal washing process, respectively. Low pH and adequate current were the most important criteria in the removal process as they provided superior desorption and transport properties. The effect of chelating by EDTA was less dominant as it delayed the removal process by forming a transport loop in anode region between Pb ion and complexes. HNO3 was not suitable as wash solution in electrokinetic washing in spite of offering highest removal efficiency as it caused pH fluctuation in the cathode chamber, corroded graphite anode and showed high power consumption. In contrast, citric acid not only yielded high Pb removal efficiency with low power consumption but also maintained a low soil: solution ratio of 1 g: <1 mL, stable pH and electrode integrity. Possible transport mechanisms for Pb under each wash solution are also discussed in this work.

An Evaluation of 1D Loss Model Collections for the Off-Design Performance Prediction of an Automotive Turbocharger Compressor

Abstract. Single-zone modelling is used to assess different collections of impeller 1D loss models. Three collections of loss models have been identified in literature, and the background to each of these collections is discussed. Each collection is evaluated using three modern automotive turbocharger style centrifugal compressors; comparisons of performance for each of the collections are made. An empirical data set taken from standard hot gas stand tests for each turbocharger is used as a baseline for comparison. Compressor range is predicted in this study; impeller diffusion ratio is shown to be a useful method of predicting compressor surge in 1D, and choke is predicted using basic compressible flow theory. The compressor designer can use this as a guide to identify the most compatible collection of losses for turbocharger compressor design applications. The analysis indicates the most appropriate collection for the design of automotive turbocharger centrifugal compressors.

An Evaluation of 1D Design Methods for the Off-Design Performance Prediction of Automotive Turbocharger Compressors

Several one-dimensional design methods have been used to predict the off-design performance of three modern centrifugal compressors for automotive turbocharging. The three methods used are single-zone, two-zone, and a more recent statistical method. The predicted results from each method are compared against empirical data taken from standard hot gas stand tests for each turbocharger. Each of the automotive turbochargers considered in this study have notably different geometries and are of varying application. Due to the non-adiabatic test conditions, the empirical data has been corrected for the effect of heat transfer to ensure comparability with the 1D models. Each method is evaluated for usability and accuracy in both pressure ratio and efficiency prediction. The paper presents an insight into the limitations of each of these models when applied to one-dimensional automotive turbocharger design, and proposes that a corrected single-zone modelling approach has the greatest potential for further development, whilst the statistical method could be immediately introduced to a design process where design variations are limited.

An Evaluation of Vaneless Diffuser Modelling Methods as a Means of Improving the Off-Design Performance Prediction of Centrifugal Compressors

An evaluation of existing 1-D vaneless diffuser design tools in the context of improving the off-design performance prediction of automotive turbocharger centrifugal compressors is described. A combination of extensive gas stand test data and single passage CFD simulations have been employed in order to permit evaluation of the different methods, allowing conclusions about the relative benefits and deficiencies of each of the different approaches to be determined. The vaneless diffuser itself has been isolated from the incumbent limitations in the accuracy of 1-D impeller modelling tools through development of a method to fully specify impeller exit conditions (in terms of mean quantities) using only standard test stand data with additional interstage static pressure measurements at the entrance to the diffuser. This method allowed a direct comparison between the test data and 1-D methods through sharing common inputs, thus achieving the aim of diffuser isolation.

Crucial to the accuracy of determining the performance of each of the vaneless diffuser configurations was the ability to quantify the presence and extent of the spanwise aerodynamic blockage present at the diffuser inlet section. A method to evaluate this critical parameter using CFD data is described herein, along with a correlation for blockage related to a new diffuser inlet flow parameter ⚡, equal to the quotient of the local flow coefficient and impeller tip speed Mach number. The resulting correlation permitted the variation of blockage with operating condition to be captured.

Building performance evaluation of domestic energy efficient retrofits in current and future climates

Approximately half of the houses in Northern Ireland were built before any form of minimum thermal specification or energy efficiency standard was enforced. Furthermore, 44% of households are categorised as being in fuel poverty; spending more than 10% of the household income to heat the house to bring it to an acceptable level of thermal comfort. To bring existing housing stock up to an acceptable standard, retrofitting for improving the energy efficiency is essential and it is also necessary to study the effectiveness of such improvements in future climate scenarios. This paper presents the results from a year-long performance monitoring of two houses that have undergone retrofits to improve energy efficiency. Using wireless sensor technology internal temperature, humidity, external weather, household gas and electricity usage were monitored for a year. Simulations using IES-VE dynamic building modelling software were calibrated using the monitoring data to ASHARE Guideline 14 standards. The energy performance and the internal environment of the houses were then assessed for current and future climate scenarios and the results show that there is a need for a holistic balanced strategy for retrofitting.

An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

Use of the Child Health Questionnaire in Children with Cerebral Palsy: A Systematic Review and Evaluation of the Psychometric Properties

Objective: To review the psychometric performance of the Child Health Questionnaire (CHQ) in samples ofchildren with cerebral palsy (CP).

Method: Four search terms were applied to five databases in a search forpapers published between 1993 and January 2007.

Results: A total of 13 papers were identified, providingdata on 1229 unique children aged 2–18 years old. Three studies reported on the reliability of the CHQ(internal consistency), whilst six studies provided evidence on various dimensions of validity (concurrent;discriminant and item discriminant validity).

Conclusions: This review identified a number ofpsychometric issues that need to be addressed. These include the assessment of additional types of reliability;an examination of the factor structure of the CHQ within the CP population; and the development ofnormative data using substantial representative samples, particularly in Europe. Until these issues areaddressed, researchers utilizing the CHQ in children with CP should be cautious about its interpretation.

TDM modelling and evaluation of different domain transforms for LSI

Latent semantic indexing (LSI) is a popular technique used in information retrieval (IR) applications. This paper presents a novel evaluation strategy based on the use of image processing tools. The authors evaluate the use of the discrete cosine transform (DCT) and Cohen Daubechies Feauveau 9/7 (CDF 9/7) wavelet transform as a pre-processing step for the singular value decomposition (SVD) step of the LSI system. In addition, the effect of different threshold types on the search results is examined. The results show that accuracy can be increased by applying both transforms as a pre-processing step, with better performance for the hard-threshold function. The choice of the best threshold value is a key factor in the transform process. This paper also describes the most effective structure for the database to facilitate efficient searching in the LSI system.

Development and Longer Term In Situ Evaluation of Fiber-Optic Sensors for Monitoring of Structural Concrete

In this paper, new solutions to the problem of making measurements, of carbonation and chloride ingress, in particular, in concrete structures are considered. The approach has focused on the design, development, and use of fiber-optic sensors (FOSs), recognizing the need in that conventional devices are often either inaccurate, expensive, or unsuitable for encapsulation in the material. The sensors have been designed to monitor, in situ and nondestructively, relevant physical, and chemical changes in cementitious materials. Three different types of FOS were constructed, tested, and evaluated specifically for this application, these being a temperature sensor (based on the fluorescence decay) and pH and chloride sensors, based on sol-gel (solidified gel) technology with appropriate impregnated indicators. The sensors were all designed to be inserted into the structures and evaluated under the harshest conditions, i.e., being mounted when the mortar is poured and thus tested in situ, with the temperature and pH sensors successfully embedded in mortar. The outcomes of these tests have shown that both the temperature sensor and the pH sensor were able to function correctly for the duration of the work - for over 18 months after placement. The laboratory tests on the chloride sensor showed it was able to make measurements but was not reversible, limiting its potential utility for in situ environments. Research is ongoing to refine the sensor performance and extend the testing.