Feasibility of a stepped wedge cluster RCT and concurrent observational sub-study to evaluate the effects of modified ward night lighting on inpatient fall rates and sleep quality: A protocol for a pilot trial

Background: Falls among hospitalised patients impose a considerable burden on health systems globally and prevention is a priority. Some patient-level interventions have been effective in reducing falls, but others have not. An alternative and promising approach to reducing inpatient falls is through the modification of the hospital physical environment and the night lighting of hospital wards is a leading candidate for investigation. In this pilot trial, we will determine the feasibility of conducting a main trial to evaluate the effects of modified night lighting on inpatient ward level fall rates. We will test also the feasibility of collecting novel forms of patient level data through a concurrent observational sub-study. Methods/design: A stepped wedge, cluster randomised controlled trial will be conducted in six inpatient wards over 14 months in a metropolitan teaching hospital in Brisbane (Australia). The intervention will consist of supplementary night lighting installed across all patient rooms within study wards. The planned placement of luminaires, configurations and spectral characteristics are based on prior published research and pre-trial testing and modification. We will collect data on rates of falls on study wards (falls per 1000 patient days), the proportion of patients who fall once or more, and average length of stay. We will recruit two patients per ward per month to a concurrent observational sub-study aimed at understanding potential impacts on a range of patient sleep and mobility behaviour. The effect on the environment will be monitored with sensors to detect variation in light levels and night-time room activity. We will also collect data on possible patient-level confounders including demographics, pre-admission sleep quality, reported vision, hearing impairment and functional status. Discussion: This pragmatic pilot trial will assess the feasibility of conducting a main trial to investigate the effects of modified night lighting on inpatient fall rates using several new methods previously untested in the context of environmental modifications and patient safety. Pilot data collected through both parts of the trial will be utilised to inform sample size calculations, trial design and final data collection methods for a subsequent main trial.

El gráfico y las Malvinas. Periodismo deportivo en tiempos de guerra

Introducción: /.../ Uno de los acontecimientos durante el siglo pasado en los que se entremezcló la política con el deporte fue la Guerra de las Malvinas. Entre el 2 de abril y el 14 de junio de 1982, al mismo tiempo que se desarrollaban los hechos en el Atlántico Sur, el deporte argentino siguió su accionar con diferentes resultados. En medio de una feroz campaña mediática, que analizaremos más adelante, los diversos hechos deportivos que tuvieron como protagonistas a los deportistas de nuestro país se vieron reflejados en las páginas de El Gráfico. Dentro de nuestro estudio, consideramos que esa publicación no estuvo al margen de lo que sucedió en Malvinas. Nuestra hipótesis estará centrada en demostrar el apoyo editorial, como un apéndice de lo que Atlántida hizo al mismo tiempo con revistas como Gente y Somos. En resumen, la intención de la editorial en transformar al deporte y sus triunfos como una gesta épica. Y, también, la elección de héroes como vehículos de comunicación de nacionalismo.

La corriente de Malvinas. Ramas y frentes oceánicos en el mar patagónico

La corriente de Malvinas corre de sur a norte sobre el borde del talud que marca el fin de la plataforma continental patagónica (océano Atlántico sudoccidental), a lo largo de unos 1800 kilómetros. Su presencia da lugar a una zona del mar con muy rica diversidad biológica y ecológica, lo que incluye pesquerías de importancia económica regional. Los datos satelitales permiten avanzar el estudio del mar patagónico en una zona en que las aguas de la plataforma continental cambian de temperatura por efecto de la corriente fría de Malvinas, lo que influye notablemente sobre la vida marina. Este artículo de divulgación científica incluye información sobre frentes oceánicos del Mar Argentino, datos satelitales y detección de ramas y frentes térmicos, la ecología de las especies marinas, finalizando con lecturas sugeridas.

Stress on the ward: evidence of safety tipping points in hospitals

Do hospitals experience safety tipping points as utilization increases, and if so, what are the implications for hospital operations management? We argue that safety tipping points occur when managerial escalation policies are exhausted and workload variability buffers are depleted. Front-line clinical staff is forced to ration resources and, at the same time, becomes more error prone as a result of elevated stress hormone levels. We confirm the existence of safety tipping points for in-hospital mortality using the discharge records of 82,280 patients across six high-mortality-risk conditions from 256 clinical departments of 83 German hospitals. Focusing on survival during the first seven days following admission, we estimate a mortality tipping point at an occupancy level of 92.5%. Among the 17% of patients in our sample who experienced occupancy above the tipping point during the first seven days of their hospital stay, high occupancy accounted for one in seven deaths. The existence of a safety tipping point has important implications for hospital management. First, flexible capacity expansion is more cost-effective for safety improvement than rigid capacity, because it will only be used when occupancy reaches the tipping point. In the context of our sample, flexible staffing saves more than 40% of the cost of a fully staffed capacity expansion, while achieving the same reduction in mortality. Second, reducing the variability of demand by pooling capacity in hospital clusters can greatly increase safety in a hospital system, because it reduces the likelihood that a patient will experience occupancy levels beyond the tipping point. Pooling the capacity of nearby hospitals in our sample reduces the number of deaths due to high occupancy by 34%.

超对称电磁相互作用系统的BRST量子化及其正则Ward恒等式

运用Becchi-Rouet-Stora-Tyutin路径积分量子化方法对超对称电磁相互作用系统进行了量子化.在相空间中化简了超对称电磁相互作用系统Hamiltonian量,进而使该系统的量子化被化简.构造体系的BRST生成元,得到了系统的BRST变换;给出了有效作用量,得到了Green函数生成泛函;构造了体系的规范生产元,并得到了系统的规范对称变换.最后,基于正则系统的Noether定理,给出了规范变换的Ward-Takahashi恒等式,进而讨论了正规顶角和传播子的关系,给出了正规顶角和传播子的两个关系式.

BRST quantization and canonical Ward identity of the supersymmetric electromagnetic interaction system

According to the method of path integral quantization for the canonical constrained system in Becchi-Rouet-Stora-Tyutin scheme, the supersymmetric electromagnetic interaction system was quantized. Both the Hamiltonian of the supersymmetric electromagnetic interaction system in phase space and the quantization procedure were simplified. The BRST generator was constructed, and the BRST transformations of supersymmetric fields were gotten; the effective action was calculated, and the generating functional for the Green function was achieved; also, the gauge generator was constructed, and the gauge transformation of the system was obtained. Finally, the Ward-Takahashi identities based on the canonical Noether theorem were calculated, and two relations between proper vertices and propagators were obtained.

A view of the history, literature, and religion of the Hindoos : including a minute description of their manners and customs, and translations from their principal works / by Rev. W. Ward.

http://www.archive.org/details/wardshidoos00sethuoft