Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

How to recognise a kick : A cognitive task analysis of drillers’ situation awareness during well operations

Acknowledgements This article is based on a doctoral research project of the first author which was sponsored by an international drilling rig operator. The views presented are those of the authors and should not be taken to represent the position or policy of the sponsor. The authors wish to thank the industrial supervisor and the drilling experts for their contribution and patience, as well as Aberdeen Drilling School for allowing the first author to attend one of their well control courses.

From ‘poor parenting’ to micro-management:coalition governance and the sponsorship of arm’s-length bodies in the United Kingdom, 2010–13

The delegation of public tasks to arm’s-length bodies remains a central feature of contemporary reform agendas within both developed and developing countries. The role and capacity of political and administrative principals (i.e. ministers and departments of state) to control the vast network of arm’s-length bodies for which they are formally responsible is therefore a critical issue within and beyond academe. In the run-up to the 2010 General Election in the United Kingdom, the ‘quango conundrum’ emerged as an important theme and all three major parties committed themselves to shift the balance of power back towards ministers and sponsor departments. This article presents the results of the first major research project to track and examine the subsequent reform process. It reveals a stark shift in internal control relationships from the pre-election ‘poor parenting’ model to a far tighter internal situation that is now the focus of complaints by arm’s-length bodies of micro-management. This shift in the balance of power and how it was achieved offers new insights into the interplay between different forms of governance and has significant theoretical and comparative relevance. Points for practitioners: For professionals working in the field of arm’s-length governance, the article offers three key insights. First, that a well-resourced core executive is critical to directing reform given the challenges of implementing reform in a context of austerity. Second, that those implementing reform will also need to take into account the diverse consequences of centrally imposed reform likely to result in different departments with different approaches to arm’s-length governance. Third, that reforming arm’s-length governance can affect the quality of relationships, and those working in the field will need to mitigate these less tangible challenges to ensure success.

Algorithme de branch-and-price-and-cut pour le problème de conception de réseaux avec coûts fixes, capacités et un seul produit

De nombreux problèmes liés aux domaines du transport, des télécommunications et de la logistique peuvent être modélisés comme des problèmes de conception de réseaux. Le problème classique consiste à transporter un flot (données, personnes, produits, etc.) sur un réseau sous un certain nombre de contraintes dans le but de satisfaire la demande, tout en minimisant les coûts. Dans ce mémoire, on se propose d'étudier le problème de conception de réseaux avec coûts fixes, capacités et un seul produit, qu'on transforme en un problème équivalent à plusieurs produits de façon à améliorer la valeur de la borne inférieure provenant de la relaxation continue du modèle. La méthode que nous présentons pour la résolution de ce problème est une méthode exacte de branch-and-price-and-cut avec une condition d'arrêt, dans laquelle nous exploitons à la fois la méthode de génération de colonnes, la méthode de génération de coupes et l'algorithme de branch-and-bound. Ces méthodes figurent parmi les techniques les plus utilisées en programmation linéaire en nombres entiers. Nous testons notre méthode sur deux groupes d'instances de tailles différentes (gran-des et très grandes), et nous la comparons avec les résultats donnés par CPLEX, un des meilleurs logiciels permettant de résoudre des problèmes d'optimisation mathématique, ainsi qu’avec une méthode de branch-and-cut. Il s'est avéré que notre méthode est prometteuse et peut donner de bons résultats, en particulier pour les instances de très grandes tailles.

Using virtual topology operations to generate analysis topology

Virtual topology operations have been utilized to generate an analysis topology definition suitable for downstream mesh generation. Detailed descriptions are provided for virtual topology merge and split operations for all topological entities. Current virtual topology technology is extended to allow the virtual partitioning of volume cells and the topological queries required to carry out each operation are provided. Virtual representations are robustly linked to the underlying geometric definition through an analysis topology. The analysis topology and all associated virtual and topological dependencies are automatically updated after each virtual operation, providing the link to the underlying CAD geometry. Therefore, a valid description of the analysis topology, including relative orientations, is maintained. This enables downstream operations, such as the merging or partitioning of virtual entities, and interrogations, such as determining if a specific meshing strategy can be applied to the virtual volume cells, to be performed on the analysis topology description. As the virtual representation is a non-manifold description of the sub-divided domain the interfaces between cells are recorded automatically. This enables the advantages of non-manifold modelling to be exploited within the manifold modelling environment of a major commercial CAD system, without any adaptation of the underlying CAD model. A hierarchical virtual structure is maintained where virtual entities are merged or partitioned. This has a major benefit over existing solutions as the virtual dependencies are stored in an open and accessible manner, providing the analyst with the freedom to create, modify and edit the analysis topology in any preferred sequence, whilst the original CAD geometry is not disturbed. Robust definitions of the topological and virtual dependencies enable the same virtual topology definitions to be accessed, interrogated and manipulated within multiple different CAD packages and linked to the underlying geometry.

A Value Networks Approach to Implementing Integrated Cross-National Business Operations

The removal of trade impediments is expected to cause companies to integrate more of their operations among countries; however, experience shows that behavioral factors often impede the requisite cooperation and commitment among managers from different countries. This paper discusses these behavioral problems from a national perspective and examines an approach to integration, value networks, which is not bounded by nation-states and their differences or similarities.

Mixture of time-dependent growth models with an application to blue swimmer crab length-frequency data

Understanding how aquatic species grow is fundamental in fisheries because stock assessment often relies on growth dependent statistical models. Length-frequency-based methods become important when more applicable data for growth model estimation are either not available or very expensive. In this article, we develop a new framework for growth estimation from length-frequency data using a generalized von Bertalanffy growth model (VBGM) framework that allows for time-dependent covariates to be incorporated. A finite mixture of normal distributions is used to model the length-frequency cohorts of each month with the means constrained to follow a VBGM. The variances of the finite mixture components are constrained to be a function of mean length, reducing the number of parameters and allowing for an estimate of the variance at any length. To optimize the likelihood, we use a minorization–maximization (MM) algorithm with a Nelder–Mead sub-step. This work was motivated by the decline in catches of the blue swimmer crab (BSC) (Portunus armatus) off the east coast of Queensland, Australia. We test the method with a simulation study and then apply it to the BSC fishery data.

Hierarchical clustering with multiple-height branch-cut applied to short time-series gene expression data.

Rigid adherence to pre-specified thresholds and static graphical representations can lead to incorrect decisions on merging of clusters. As an alternative to existing automated or semi-automated methods, we developed a visual analytics approach for performing hierarchical clustering analysis of short time-series gene expression data. Dynamic sliders control parameters such as the similarity threshold at which clusters are merged and the level of relative intra-cluster distinctiveness, which can be used to identify "weak-edges" within clusters. An expert user can drill down to further explore the dendrogram and detect nested clusters and outliers. This is done by using the sliders and by pointing and clicking on the representation to cut the branches of the tree in multiple-heights. A prototype of this tool has been developed in collaboration with a small group of biologists for analysing their own datasets. Initial feedback on the tool has been positive.

Rough sketch of the country from Lake Champlain and the River Sorell extending to the eastward as far as the River St. Francois and the Cohos on the Connecticut, shewing the march of 21 officers & Canadians in October and November 1780 under the command of Lieutenant Colonel Carleton, in order to discover the road cut by the rebels under the direction of Colonel Hazen in the year 1778 & 1779.

Scale not given.

SMS length and function: A comparative study of 13- to 18-year-old girls and boys

International audience

Algorithme de branch-and-price-and-cut pour le problème de conception de réseaux avec coûts fixes, capacités et un seul produit

De nombreux problèmes liés aux domaines du transport, des télécommunications et de la logistique peuvent être modélisés comme des problèmes de conception de réseaux. Le problème classique consiste à transporter un flot (données, personnes, produits, etc.) sur un réseau sous un certain nombre de contraintes dans le but de satisfaire la demande, tout en minimisant les coûts. Dans ce mémoire, on se propose d'étudier le problème de conception de réseaux avec coûts fixes, capacités et un seul produit, qu'on transforme en un problème équivalent à plusieurs produits de façon à améliorer la valeur de la borne inférieure provenant de la relaxation continue du modèle. La méthode que nous présentons pour la résolution de ce problème est une méthode exacte de branch-and-price-and-cut avec une condition d'arrêt, dans laquelle nous exploitons à la fois la méthode de génération de colonnes, la méthode de génération de coupes et l'algorithme de branch-and-bound. Ces méthodes figurent parmi les techniques les plus utilisées en programmation linéaire en nombres entiers. Nous testons notre méthode sur deux groupes d'instances de tailles différentes (gran-des et très grandes), et nous la comparons avec les résultats donnés par CPLEX, un des meilleurs logiciels permettant de résoudre des problèmes d'optimisation mathématique, ainsi qu’avec une méthode de branch-and-cut. Il s'est avéré que notre méthode est prometteuse et peut donner de bons résultats, en particulier pour les instances de très grandes tailles.

A Performance Measurement System to Manage CEN Operations, Evolution and Innovation

Part 16: Performance Measurement Systems

Plan of York Town in Virginia and adjacent country, exhibiting the operations of the American, French & English armies during the siege of that place in Oct. 1781. Surveyed from the 22nd. to the 28th. Octr.

Scale ca. 1:14,400.