The objectives of the study were to identify the incidence rate and characteristics of adverse drug events (ADEs) in nursing homes (NHs) using the ADE trigger tool and to evaluate the relationships between resident and facility work system factors and incidence of ADEs using the System Engineering Initiative for Patient Safety (SEIPS) model. The study used 2 observational quantitative methods, retrospective resident chart extraction, and surveys. The participating staff included Directors of nursing, registered nurses, certified nurse assistants (CNAs). Data were collected from fall 2016 to spring 2017 from 11 NHs in 9 cities in Iowa. Binary logistic regression with generalized estimated equations was used to measure the association between ADE incidence and resident and facility characteristics. We extracted data from 755 medical charts and conducted 33 staff surveys. There were 6.13 ADEs per 100 residents per month. More than half were fall‐related (51.1%), and half of those were due to hypotension. Regression analysis revealed significant associations between ADEs and opioid analgesics, psychotropic medications, warfarin, skilled care, consultant pharmacist accessibility, nurse‐physician collaboration, CNA vital sign assessment skills, number of physician visits, nurse workload, and use of electronic health records. Five resident characteristics (skilled care, dementia, use of opioids, warfarin, psychotropics) and variables from 5 domains of the facility work system (organization, task, environment, person, technology) had significant associations with ADE incidence. The SEIPS model successfully identified work system factors influencing ADEs in NHs.
The city is a built-up urban space and multifunctional structures that ensure safety, health and the best shelter for humans. All its built structures had various urban roofs influenced by different climate circumstances. That creates peculiarities and changes within the urban local climate and an increase in the impact of urban heat islands (UHI) with wastage of energy. The research question is less information dealing with the renovation of existing urban roofs using color as a strategy to mitigate the impact of UHI. In order to achieve local urban sustainability; the research focused on solutions using different materials and treatments to reduce urban surface heating emissions. The results showed that the new and old technologies, produ
... Show MoreToni Morrison (1931-), the first African-American winner of Noble Prize in literature (1993) and the winner of the 1988 Pulitzer Prize for fiction, regards herself as the historian of African-American people. She does not think of her writings as literature but as a sacred book dedicated to explore the interior lives of blacks. She creates history by disregarding European standards and the white man's view of African- Americans. She adopts her people's point of view, invests their heritage, voices their pains and uses their vernacular. She even writes to a black audience. She establishes the black novel by depicting the blackness of American literature. In choos
... Show MoreThe effect of linear thermal stratification in stable stationary ambient fluid on free convective flow of a viscous incompressible fluid along a plane wall is numerically investigated in the present work. The governing equations of continuity, momentum and energy are solved numerically using finite difference method with Alternating Direct implicit Scheme. The velocity, temperature distributions
and the Nusselt number are discussed numerically for various values of physical parameters and presented through graphs. ANSYS program also used to solve the problem. The results show that the effect of stratification parameter is marginalized with the increase in Prandtl number, and the increase in Grashof number does not practically vary the
This paper develops a fuzzy multi-objective model for solving aggregate production planning problems that contain multiple products and multiple periods in uncertain environments. We seek to minimize total production cost and total labor cost. We adopted a new method that utilizes a Zimmermans approach to determine the tolerance and aspiration levels. The actual performance of an industrial company was used to prove the feasibility of the proposed model. The proposed model shows that the method is useful, generalizable, and can be applied to APP problems with other parameters.
William Shakespeare's play Coriolanus explores the journey of power and the transformation of a skilled warrior into a statesman. This paper employs Machiavelli’s framework of pragmatic statecraft to analyse Coriolanus’s tragic failure as a political leader despite his unparalleled prowess as a Roman general. It analyses Coriolanus's political career, revealing how his military skills, while effective in warfare, do not translate into political success. The paper shows that Coriolanus’s contempt for performative politics, refusal to adopt civic diplomacy, and failure to soften aristocratic pride with populist appeal turn plebeians against him and alienate patricians. His upholding of martial honour — fostered by his mother Volumnia
... Show MoreThe purpose of this study is aimed to lay down an arranged platform suited to Iraqi constructional associations which in charge to carry out multi constructional projects, as it fulfilled management requirements and supervising, so that low - cost projects will be controlled in due term and quality. Based on primary info and observed data collected, the study thesis has been formulated in this way: Iraqi constructional sector bodies which are in charge to implement simultaneously multi constructional projects in need to reformulate its organized structure so that it will be more fitted to management and control of these projects. This thesis includes a
theoretical part contained presenting the most important resources locally and int
The purpose of this interview study was to explore teachers’ perceptions of Response to Intervention (RtI) implementation in their school. Particularly, the study explored teachers’ knowledge of RtI, teachers’ perceptions of RtI their intervention/instruction in school, and teachers’ suggestions of RtI implementation in their school. The study design was a qualitative interview in nature and data were collected from face-to-face interviews with four teachers in one school. The findings revealed that RtI means to identify students’ problems; the positive teachers’ perceptions of their implementation included: (a) students who demonstrate progress through RtI are those who receive private education services, (b) progress monito
... Show MoreThe issue of the development of Qur'anic studies for the tasks, and the first thought of minds and multiple understandings, and the most precious ideas, and the alternatives were floated, and varied visions, especially as we live in an era exploding knowledge, and complicate secretions, and scramble his ideas, and to devise intellectual approaches To achieve the witnesses of civilization in the words of the Almighty (to be martyrs on the people) Surat Al - Baqarah / 143 attendance and participation in the achievement and a positive interaction with the participants of humanity and civilization in the light of the meaning (to know) rooms / 13.
Therefore, we must emerge from the one-dimensional view of the Koran to the complex mindset t
The Geographic Information System (GIS) is considered one of the most prominent programs used to collect, analyze, display, process, and produce geographic information maps for a specific purpose. It is also considered one of the modern database programs. Additionally, we can perform statistical analysis within GIS on predefined data to produce quantitative results. In this study, data was collected from more than 80 engineering projects established in Baghdad City from soil investigation reports for the projects. Geographic information systems were used to produce objective maps showing the variation in the bearing capacity of shallow foundations in the soil of Baghdad Governorate. I