Mohawk College

This research examines the potential for new Health Level 7 (HL7) standard Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) standard to help achieve healthcare systems interoperability. HL7 messaging standards are widely implemented by the healthcare industry and have been deployed internationally for decades. HL7 Version 2 (“v2”) health information exchange standards are a popular choice of local hospital communities for the exchange of healthcare information, including electronic medical record information. In development for 15 years, HL7 Version 3 (“v3”) was designed to be the successor to Version 2, addressing Version 2's shortcomings. HL7 v3 has been heavily criticized by the industry for being internally inconsistent even in it's own documentation, too complex and expensive to implement in real world systems and has been accused of contributing towards many failed and stalled systems implementations. HL7 is now experimenting with a new approach to the development of standards with FHIR. This research provides a chronicle of the evolution of the HL7 messaging standards, an introduction to HL7 FHIR and a comparative analysis between HL7 FHIR and previous HL7 messaging standards.

BACKGROUND: The current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. OBJECTIVES: The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. METHODS: A 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. RESULTS: We identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. CONCLUSIONS: There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.

The current study investigates the effects of a wide range of process parameters on three part properties; density, surface roughness, and surface residual stresses simultaneously for selective laser melting of Inconel 718. In addition to the lack of investigations on surface roughness and residual stresses in selective laser melting of Inconel 718, process maps were developed for the selection of the best process parameters to achieve the desired values for the three parameters combined. Five laser powers, six scan speeds and three hatch spacings were chosen from the stable single tracks tests. Based on each property, a 99.5% density or a 2 μm surface roughness or the least surface tensile residual stress of 248 MPa were possible. However, no single process parameter combination was able to achieve good values for all three parameters. Prioritizing density and surface roughness, being crack initiators, over residual stresses for their effect on fatigue failure, it was found that 99.2% density and relatively low roughness of 3.5 μm are feasible at 320 W, 600 mm/s and 0.12 mm hatch spacing. Finally, opposite to the commonly observed columnar grain in Inconel 718, mixed grain structure was obtained at 600 mm/s and 1000 mm/s, indicating reduced anisotropy.

BACKGROUND: The prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. Current health and social services are not addressing the complex needs of this group or their family caregivers. A better understanding of the experience of MCC from multiple perspectives is needed to improve the approach to care for this vulnerable group. However, the experience of MCC has not been explored with a broad sample of community-living older adults, family caregivers and healthcare providers. The purpose of this study was to explore the experience of managing MCC in the community from the perspectives of older adults with MCC, family caregivers and healthcare providers working in a variety of settings. METHODS: Using Thorne's interpretive description approach, semi-structured interviews (n = 130) were conducted in two Canadian provinces with 41 community-living older adults (aged 65 years and older) with three or more chronic conditions, 47 family caregivers (aged 18 years and older), and 42 healthcare providers working in various community settings. Healthcare providers represented various disciplines and settings. Interview transcripts were analyzed using Thorne's interpretive description approach. RESULTS: Participants described the experience of managing MCC as: (a) overwhelming, draining and complicated, (b) organizing pills and appointments, (c) being split into pieces, (d) doing what the doctor says, (e) relying on family and friends, and (f) having difficulty getting outside help. These themes resonated with the emotional impact of MCC for all three groups of participants and the heavy reliance on family caregivers to support care in the home. CONCLUSIONS: The experience of managing MCC in the community was one of high complexity, where there was a large gap between the needs of older adults and caregivers and the ability of health and social care systems to meet those needs. Healthcare for MCC was experienced as piecemeal and fragmented with little focus on the person and family as a whole. These findings provide a foundation for the design of care processes to more optimally address the needs-service gap that is integral to the experience of managing MCC.

Because reliability is a prerequisite for validity, it is of interest to physical therapists. But what is reliability? Mitchell states, "A reliable instrument is one with small errors of measurement, one that shows stability, consistency, and dependability of scores for individuals on the trait, characteristic or behavior being assessed."1(p377) This view is concordant wih the opinion offered by Rothstein: "Reliability is basically the consistency of a measurement."2(p5) There is, however, a second definition of reliability, that offered by classical test theory, that is somewhat different from the statements expressed above. This theory depicts reliability as being a ratio of variances; specifically, it is the variance attributed to differences among subjects divided by the total variance.3 A recurring dilemma for readers of physical therapy journals is that authors and editors have frequently contributed to publications that have not differentiated clearly between consistency and the ability to differentiate among subjects—both known as reliability.

The purpose of the study was to describe the electrical activity of the vastus medialis, rectus femoris, and vastus lateralis muscles in subjects with normal knees and acute, severely effused knees when contracting maximally at 30 degrees and 0 degrees of knee flexion. Two groups identified were 1) an effused group (n=8) with subjects having one effused knee and one normal knee and 2) a normal group (n = 8) with subjects having two normal knees. The results were evaluated on two occasions by an observer who has unfamiliar with the groups to which the subjects belonged. The repeated evaluation yielded a high reliability coefficient (Spearman Rho r = .91). Analysis revealed a marked decrease in electrical activity at 0 degrees knee flexion compared to 30 degrees knee flexion in all muscles monitored in the effused knees, while the electrical activity was about equal in both joint positions for the normal knees in both groups. A hypothesis was formed that suggests the decreased electrical activity at 0 degrees in the effused knees results from reflex inhibition caused by joint capsule distension and intra-articular pressures that change with joint position.

Abstract NBS urban particulate matter, SRM 1648, has been analyzed by a sequential extraction procedure to determine the chemical forms of P, AI, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn. High proportions of P, Cd, Co, Cu, Ni, Pb and Zn were found to be in soluble and/or exchangeable forms which are potentially readily bioavailable.

ABSTRACT: Recognizing the need to assess the caring aspects of childbirth care, we developed a Labor and Delivery Satisfaction Index (LADSI) for use in clinical trials of options for delivery. Thirty‐eight items were constructed after extensive consultation with recent mothers and clinicians, and each was worded as a statement for ratings of agreement or disagreement on a six‐point scale. Fifty‐nine unselected women completed the index two days postpartum, and 35 of them completed it again at four to six weeks postpartum. Analysis of these data showed the LADSI to have stability over time with a correlation of 0.67 between test and retest, face validity to mothers and clinicians, construct validity by showing significantly different satisfaction scores among groups expected a priori to differ significantly, and enough internal consistency to use total scores (average item‐total correlations of 0.5), but not enough to use subcomponent scores (Cronbach's alpha = 0.35). On the basis of this study, differences of as little as 10 percent in the scores of different groups of women on the LADSI represent clinically important differences in levels of satisfaction with labor and delivery.

An aerodynamic gradient micrometeorological approach to the measurement of total gaseous mercury (TGM) flux has been developed. This method has been applied in many field studies for the characterization of TGM flux from various mercuriferous substrates. The resolution of the gradient method depends on the sampling systems characteristics and has been demonstrated to be on the order of 0.01 ± 0.01 ng Hg m −3 or better. The method is best suited to measuring high‐emitting sites such as studied here. The TGM flux resolution is based on the gradient resolution and depends on the site characteristics and the atmospheric condition. For a typical friction velocity u * of 0.1 m s −1 and gradient intake heights of 0.15 and 0.4 m the method can resolve a TGM flux on the order of 1.5 ng m −2 h −1 . The system can be configured for two‐level or multilevel sampling, as needed. The method compares well with other micrometeorological methods as demonstrated during the Nevada storms intercomparison study. The micrometeorological method is shown to compare well with chamber techniques under comparable conditions.

Examination of the alkaloids of Lycopodium magellanicum (Palisot de Beauvois) has revealed the presence of five alkaloids of established structure and a previously unreported alkaloid, magellanine (C 17 H 25 NO 2 ). The ring System of magellanine, deduced from an examination of its spectroscopic properties, is identical with that of paniculatine. The structure of magellanine has been confirmed, and its relative stereochemistry established, in an X-ray crystallographic study.

BACKGROUND: There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. METHODS: Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. RESULTS: Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. CONCLUSIONS: A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG.

The beneficial effects of a Glomus deserticola strain isolated from the rhizosphere of grasses (belonging to Poaceae family) growing along the industrial waste from a distillery were investigated under stress conditions. The study was conducted to assess the efficacy of the arbuscular mycorrhizal (AM) fungal ecotype in salinity and heavy metal (HM) tolerance of eggplant (Solanum melongena L.) in soils amended with various stress levels of NaCl, zinc and cadmium. Mycorrhizal (M) seedlings produced a significantly (p < 0.05) greater growth response and were more tolerant to salt and HM stresses than nonmycorrhizal (NM) seedlings in all treatments. The HM contents in the plant tissues were significantly higher in M than NM eggplants. Furthermore, when the efficacy was compared with other AM isolates in HM-polluted soils with Sudan grass (Sorghum sudanese Staph.) as a test plant, the AM ecotype responded best to these soils, as evident from the significantly greater growth response and its aggressiveness in colonizing roots in all soil types tested. These results suggest that this G. deserticola ecotype can be used as an effective tool to alleviate the adverse effects of excessive salinity and HM toxicity on plant growth. Finally, the isolate may have potential in the bioremediation of polluted soils.

The need for in vivo bone strontium assessment arises because strontium may exert a number of effects on bone, which may be either beneficial or toxic. Measurements discussed here are noninvasive, no sample is taken, nor is there discomfort to patients. The developed source excited x-ray fluorescence system employs a 109Cd source to excite the strontium K x rays, with the source and detector in approximately 90 degree geometry relative to the sample position. The factors affecting the accuracy and minimal detectable limit for bone strontium in vivo measurements are discussed. A system calibration revealed a minimum detectible limit of approximately 0.25 mg Sr/g Ca, which is sufficient for the monitoring of strontium levels in healthy subjects and patients with elevated bone strontium concentrations. Preliminary in vivo measurements in ten healthy subjects at two bone sites (phalanx and tibia) indicated that this system can be applied for cumulative bone strontium estimation while delivering a low effective dose of 80 nSv during the measurement time. Future work will involve attempts to enhance system precision with alternative fluorescing sources and further optimization of the detection system.

Due to signal attenuation in overlying soft tissue, development of x‐ray fluorescence systems to measure low atomic number elements, such as strontium, in human bone required a search for a skeletal site with thin overlying tissue. This paper reports ultrasound measurements of overlying tissue on 10 subjects, at four anatomical sites. The average tissue thickness at the finger was The average tissue thicknesses were and at forehead, tibia and heel, respectively. Additionally, both parametric and nonparametric approaches to the relationship between body mass index (BMI) and tissue thickness suggest that there is a significant linear correlation between the subject's BMI and overlying tissue at the finger and heel bone. These correlations might be used as a criterion to perform XRF measurements, however a larger data set is required to address these correlations more clearly.

This paper presents one of the first studies of the harmonic impact of a significantly large photovoltaic (PV) solar farm of 20 MW in a utility distribution system. This solar farm is a constituent of the 80-MW PV solar farm in Sarnia, Ontario, which is so far the largest solar farm in Canada. The utility network is modeled in detail using the commercial grade PSCAD/EMTDC software, which is validated through load flow studies conducted by CYME software and correlated with SCADA measurements. The validated network model is used for network resonance study and harmonics impact analysis of the solar farms under different network conditions. The harmonics data instrumented for several months were provided by the transmission utility at the two solar farm units and at the main feeder substation. These data were utilized for extensive harmonic impact studies with widely different short-circuit levels and network resonance conditions. This paper presents the detailed procedure adopted for performing such harmonic impact studies. It is concluded that this large solar farm may not cause any substantial voltage distortion on the distribution network during steady-state operating conditions. However, recommendations are made for utilities to perform such studies to ensure the safe operation of critical loads.

BACKGROUND: Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to look to new approaches. Research utilization involves a learning process engaging attitudes, beliefs, and behaviors; yet, this is often overlooked in approaches and models used to facilitate research use. This oversight may offer some explanation to the limited progress in research utilization to date. Transformation Theory offers an explanatory theory and specific strategies (critical reflection and critical discourse) to explore attitudes, beliefs, and behaviors so that they are understood, validated, and can better guide actions. AIM: The purpose of this article was to explore what Transformation Theory can contribute to research utilization initiatives in nursing practice. APPROACH: Transformation Theory and transformative learning strategies are discussed and critically analyzed in consideration of their potential roles in fostering research utilization in clinical nursing practice. ISSUES AND CONCLUSIONS: (1) Research utilization is a learning process that involves knowledge, skills, feelings, attitudes, and beliefs. (2) Transformative learning strategies of critical reflection and discourse can facilitate insight into experiences, finding shared meanings among groups of people, and understanding/validating beliefs, attitudes, and feelings so they can more consciously guide future actions. This dimension is frequently neglected in research utilization efforts. (3) In combination with research utilization theories, Transformation Theory may be a missing link to make research utilization initiatives more effective in rendering and sustaining nursing practice change, thus enhancing client care and well-being. (4) Research and further consideration are both warranted and needed.

An x-ray fluorescence (XRF) system using 125I as the source was developed to measure strontium in bone in vivo. As part of an in vivo pilot study, 22 people were measured at two bone sites, namely the index finger and the tibial ankle joint. Ultrasound measurements were used to obtain the soft tissue thickness at each site, which was necessary to correct the signal for tissue attenuation. For all 22 people, the strontium peak was clearly distinguishable from the background, proving that the system is able to measure Sr in vivo in people having normal bone Sr levels. Monte Carlo simulations were carried out to test the feasibility and the limitations of using the coherently scattered peak at 35.5 keV as a means to normalize the signal to correct for the bone size and shape. These showed that the accuracy of the normalized Sr signal when comparing different people is about 12%. An interesting result arising from the study is that, in the measured population, significantly higher measurements of bone Sr concentration were observed in continental Asian people, suggesting the possibility of a dietary or race dependence of the bone Sr concentration or a different bone biology between races.

Universities and educational institutions worldwide had to abruptly suspend their in-person classes and offer the rest of the term in an online for-mat. This adjustment meant that instructors had to switch their instruction format and redesign their assessment strategies to ensure good quality edu-cation. In this work, we present the methods used in two courses for this transition and the impact on student learning. Specifically, we present data from two courses: second-year engineering mathematics and first-year object-oriented programming. The online instruction was delivered covering all the objectives, and the online assessment environment was designed with all possible safeguards to maintain integrity. Our data from these assessments show that the measures were successful. Further, the data indicate that while the pandemic severely impacted the first-year students, the second-year students did not experience any learning issues in the transition. We also present the lessons learned for future improvement.

An experimental investigation in which SAE 1040 steel was cut orthogonally with fluid being forced directly into the chip-tool interface through a small hole in the rake face of the tool is described. Three fluids were used, a straight mineral oil, and the same oil containing either chlorine or sulphur. The distance of the hole from the tool tip was varied over a range of one to three times the depth of cut. Results indicate that cooling of the chip-tool interface by the injected fluid is of primary importance; and that blocking of the hole is a result of the breakdown of chloride and sulphide films caused by high temperature at the interface. An explanation of how the fluid escapes from the chip-tool interface is provided.

Ongoing curricular renewal is a necessary phenomenon in nursing education to align learning with ever-changing professional practice demands. The McMaster Mohawk Conestoga BScN Program in Hamilton, Ontario, Canada recently engaged in a comprehensive curriculum renewal. The purpose of this study was to evaluate the impact of curricular changes on students' deep learning. Faculty perceptions about student learning outcomes during final year clinical placements were gathered through a combination of individual interviews and focus groups using Interpretive Descriptive qualitative research methodology. Twenty five faculty members who supervised BScN students in clinical placements before and after curriculum renewal shared perceptions of changes in students' overall performance. The chosen clinical learning outcomes were: changes in students' performance related to person-centred care, clinical reasoning and judgment, pathophysiology, and evidence-informed decision-making. Faculty described three major themes in students' performance 1) pulling it all together, 2) seeing the whole person, and 3) finding their nursing voices. This reflected a shift to person-centred care, increasing professional confidence, and improved clinical reasoning and judgment and no changes to integrating pathophysiology or evidence-informed decision-making. In this study curriculum renewal provided an excellent starting point for the scholarship of teaching and learning within nursing education.