Search results for: Madeline W. Miller

Authors: Theresa Marie Miller, Ma. Nympha Joaquin

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The aim of this study was to check the predictive power of social-oriented and individual-oriented achievement motivation on student engagement and collaborative problem-solving skills in mathematics. A sample of 277 fourth year high school students from the Philippines were selected. Surveys and videos of collaborative problem solving activity were used to collect data from respondents. The mathematics teachers of the participants were interviewed to provide qualitative support on the data. Systemaitc correlation and regression analysis were employed. Results of the study showed that achievement motivations−SOAM and IOAM− linearly predicted student engagement but was not significantly associated to the collaborative problem-solving skills in mathematics. Student engagement correlated positively with collaborative problem-solving skills in mathematics. The results contribute to theorizing about the predictive power of achievement motivations, SOAM and IOAM on the realm of academic behaviors and outcomes as well as extend the understanding of collaborative problem-solving skills of 21st century learners.

Keywords: achievement motivation, collaborative problem-solving skills, individual-oriented achievement motivation, social-oriented achievement motivation, student engagement

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Authors: Lakmali Anthony, Madeline Gillies

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Background Breast cancer (BC) is usually managed with surgical resection. Many outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO) such as Health-Related Quality of life (HRQoL) provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods Patients who had resection of BC in a regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Results Forty-six patients completed the survey. Clinically significant levels of FCR and emotional distress were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for BC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL for breast cancer. All psychosocial factors measured were associated with HRQoL. Conclusion HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative breast cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.

Keywords: breast cancer, surgery, quality of life, regional population

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Authors: Idit Miller

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This paper examines the effect of a common organizational identity on intergroup relations of Israeli-Jews and non-Israeli Palestinians medical interns who are employed together within the Israeli hospitals, while asymmetrical relationships and ongoing conflict between the two groups still exist. Using mixed theory, which included the Intergroup contact, Othering, and the Common social identity theories, the study examines the intra-organizational identities dynamic involved within the hospital department and its effects on intergroup relations. In-depth, semi-structured interviews with the Palestinian and Jews physicians were conducted. Findings show three social identity responses are being constructed during the shared employment: Them vs. Us construction, Them vs. Us deconstruction, and an 'Organizational Us' reconstruction. Despite the inequality inherent within the intergroup relations, by holding a universal identity and using a deconstruction pattern, positive emotions are demonstrated by both sides. The adoption of a shared professional super-identity is found as an essential component for fostering and maintaining positive attitudes between the parties. This finding strengthens the significance of a long-term continuous intergroup contact inside the organization and especially between two polarized groups.

Keywords: common social identity theory, intergroup contact theory, inequality, intergroup conflict, othering theory

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Authors: Vita Kalnberzina, Lauren Miller Anderson

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The aim of the paper is to report on the results of the telecollaboration project results carried out between the students of the University of Latvia, National Louis University in the US, and Austral University in Chili during the Intercultural Communication course. The objectives of the study are 1) to compare different forms of student telecollaboration and virtual exchange, 2) to collect and analyse the student feedback on the telecollaboration project, 3) to evaluate the products (films) produced during the telecollaboration project. The methods of research used are as follows: Survey of the student feedback after the project, video text analysis of the films produced by the students, and interview of the students participating in the project. We would like to compare the results of a three-year collaboration project, where we tried out synchronous telecollaboration and asynchronous collaboration. The different variables that were observed were the impact of the different time zones, different language proficiency levels of students, and different curricula developed for collaboration. The main findings suggest that the effort spent by students to organize meetings in different time zones and to get to know each other diminishes the quality of the product developed and thus reduces the students' feeling of accomplishment. Therefore, we would like to propose that asynchronous collaboration where the national teams work on a film project specifically developed by the students of one university for the students of another university ends up with a better quality film, which in its turn appeals more to the students of the other university and creates a deeper intercultural bond between the collaborating students.

Keywords: telecollaboration, intercultural communication, synchronous collaboration, asynchronous collaboration

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Authors: Seyed Reza Mirmahdi, Seyedeh Maryam Hashemi Jabali

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This research was conducted to evaluate the effects of group spiritual therapy on increasing the life expectancy and mental health among the elderlies. This was a quasi-experimental research using a pretest-posttest design with a control group conducted over a population including all the elderly people of Tehran in 2012-13. A randomized sampling method was used to select 30 elderly people living in Parham nursing home that were then randomly assigned into two control and experimental groups of 15 people each. The instruments used were Miller’s life expectancy and mental health test (SCL.90.R) standard questionnaires. Individuals in experimental group received 12 sessions of group spiritual therapy while those in control group did not receive any kind of therapy. The tests were performed again for all the subjects (30 individuals) at the end of the experiment. To test the hypotheses, the data collected by questionnaires were analyzed using descriptive methods through relevant tables and charts and also inferential methods through the analysis of covariance using the SPSS software. Results showed that group spiritual therapy leads to a significant increase in both mental health and life expectancy in the experimental group of elderlies living in Parham nursing home compared to those in the control group.

Keywords: spiritual therapy, life expectancy, mental health, elderlies

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Authors: Jonmichael Weaver, David Miller

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Dyneema is an ultra-high molecular weight polyethylene (UHMWPE) fiber created by DSM. This fiber has many applications due to the high tensile strength, low weight, and inability to absorb water. DSM manufactures a non-woven unidirectional cross-ply [0,90]2 lamina, using the Dyneema fiber. Using this lamina system, various thickness panels are created for a 40% lighter weight alternative to Kevlar for the same ballistics protection. Environmental effects on the ply/laminate system alter the material properties, resulting in diminished ultimate performance. Understanding the specific environmental parameters and characterizing the resulting material property degradation is essential for determining the safety and reliability of Dyneema in service. Two laminas were contrasted for their response to accelerated aging by UV, humidity, and temperature cycling. Both lamina contain the same fiber, SK-99, but differ in matrix composition, Dyneema HB-210 employs a polyurethane (PUR) based matrix, and HB-212 contains a rubber-based matrix. Each system was inspected using a scanning electron microscope (SEM) and evaluated by dynamic mechanical analysis (DMA) to characterize the material property changes alongside the corresponding composite damage and matrix failure mode over the aging parameters. Overall, resulting in the HB-212 degrading faster compared with the HB-210.

Keywords: dyneema, accelerated aging, polymers, ballistics protection, armor, DSM, kevlar, composites

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Authors: Sayaka Ono, Ryutaro Imai, Tomoko Ehara, Tetsuya Matsumoto, Hajime Matsumura

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Background: Wound pH affects a number of important factors in wound healing. We previously measured the pH value of the exudates collected from second-degree burns and found that the increase in pH was observed in the burn wounds in which colonized by Staphylococcus spp., and the increase in pH was evident prior to the clinical findings of local infection. To investigate the relationship between the changes of pH value and bacterial growth, we performed in vitro study using Pseudomonas aeruginosa and liquid medium as a locally infected wound equivalent model. Methods: Pseudomonas aeruginosa standard strain (ATCCR 10145TM) was cultured at 37 °C environment in Luria Broth Miller medium. The absorbance rate which means the amount of bacteria was measured by a microplate reader 2300EnSpireTM). The pH was measured using pH-indicator strips (MColorpHastTM). The statistical analysis was performed using the product-moment correlation coefficient of Pearson's. Results: The absorbance rate and pH value were increased along with culture period. There was a positive correlation between pH value and absorbance rate (n = 27, Pearson's r = 0.985). Moreover, there was a positive correlation between pH value and the culture period (n = 18, Pearson's r = 0.901). The bacteria was well growth in the media from pH 6.6 to pH 8.0 and the pH of culture media converged at 8 -9 along with the bacterial growth. Conclusion: From these results, we conclude that pH value of the wound is correlated with the number of viable bacteria and bacterial growth periods.

Keywords: colonization, potential of hydrogen, Pseudomonas aeruginosa, wound

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Authors: Madeline Tagg, Choihoong Mui, Elizabeth Lek, Jide Menakaya

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Introduction: Simulation technology is used by neonatal teams to learn and refresh skills and gain the knowledge and confidence to care for sick neonates. In-situ simulation is considered superior to laboratory-based programmes as it closely mirrors real life situations. This study reports our experience of running regular laboratory-based simulation sessions for senior clinicians and nurses and its impact on their knowledge, skills and confidence. Methods: A before and after questionnaire survey was carried out on senior clinicians and nurses that attended a scheduled laboratory-based simulation session. Participants were asked to document their expectations before a 3-hour monthly laboratory programme started and invited to feedback their reflections at the end of the session. The session included discussion of relevant clinical guidelines, immersion in a scenario and video led debrief. The results of the survey were analysed in three skills based categories - improved, no change or a worsened experience. Results: 45 questionnaires were completed and analysed. Of these 25 (55%) were completed by consultants seven and six by nurses and trainee doctors respectively, and seven respondents were unknown. 40 (88%) rated the session overall and guideline review as good/excellent, 39 respondents (86%) rated the scenario session good/excellent and 40/45 fed back a good/excellent debrief session. 33 (73%) respondents completed the before and after questionnaire. 21/33 (63%) reflected an improved knowledge, skill or confidence in caring for sick new-bon babies, eight respondents reported no change and four fed back a worse experience after the session. Discussion: Most respondents found the laboratory based structured simulation session beneficial for their professional development. They valued equally the whole content of the programme such as guideline review and equipment training as well as the simulation and debrief sessions. Two out three participants stated their knowledge of caring for sick new-born babies had been transformed positively by the session. Sessions where simulation equipment failed or relevant staff were absent contributed to a poor educational experience. Summary: A regular structured laboratory-based simulation programme with a rich content is a credible educational resource for improving the knowledge, skills and confidence of senior clinicians caring for sick new born babies.

Keywords: knowledge, laboratory based, neonates, simulation

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Authors: J. Alcisto, M. Papakyriakou, J. Guerra, A. Dominguez, M. Miller, J. Foyos, E. Jones, N. Ula, M. Hahn, L. Zeng, Y. Li, O. S. Es-Said

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Current methods of testing for hydrogen charging are slow and time consuming. The objective of this paper was to determine if hydrogen charging can be detected quantitatively through the use of Charpy Impact (CI) testing. CI is a much faster and simpler process than current methods for detecting hydrogen charging. Steel plates were Electro Discharge Machined (EDM) into ninety-six 4340 steel CI samples and forty-eight tensile bars. All the samples were heat treated at 900°C to austentite and then rapidly quenched in water to form martensite. The samples were tempered at eight different target strengths/target temperatures (145, 160, 170, 180, 190, 205, 220, to 250KSI, thousands of pounds per square inch)/(1100, 1013, 956, 898, 840, 754, 667, 494 degrees Celsius). After a tedious process of grinding and machining v-notches to the Charpy samples, they were divided into four groups. One group was kept as received baseline for comparison while the other three groups were sent to Alcoa (Fasteners) Inc. in Torrance to be cadmium coated. The three groups were coated with three thicknesses (2, 3 and 5 mils). That means that the samples were charged with ascending hydrogen levels. The samples were CI tested and tensile tested, and the data was tabulated and compared to the baseline group of uncharged samples of the same material. The results of this study were successful and indicated that CI testing was able to quantitatively detect hydrogen charging.

Keywords: Charpy impact toughness, hydrogen charging, 4340 steel, Electro Discharge Machined (EDM)

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Authors: C. C. Igwe

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Several parts of Neem tree (Azadirachta indica) are used in traditional medicine in many West African countries for the treatment of various human diseases. The leaf, stem - bark and seed were air dried for 8, 5 and 7 days, respectively. The shells were carfully separated from the seeds, each powdered sample obtained with mechanical miller and 250 mm sieve. The neem samples were individually subjected to extraction with acetone, n-hexane for 48hr and 72 hr, respectively. Physico-chemical and antibacterial evaluation were carried out using standard methods. Results of physico - chemical analyses of the extracted oil from the seed shows that it has a brownish colour, with a smell similar to garlic while the moisture content, refractive index are 0.76% and 1.47 respectively. Other vital chemical results obtained from the neem oil such as saponification value (234.62), acid value (10.84 %), free fatty acid (5.84 %) and peroxide value (10.52%) indicated the oil extracted satisfied standard oils parameters for quality soap and cosmetics production. The antibacterial screening by disc diffusion revealed the oil demonstrated high activity against Staphylococcus aureus. Both the physio-chemical and antibacterial of samples have been certified by National Agency for Food and Drugs Administration and Control. The preliminary results of this study may validate the medicinal value of the plant. Further studies are in progress to clarify the in vivo potentials of neem extracts in the management of human communicable diseases and this is a subject of investigation in our group.

Keywords: anti-bacterial, neem extract, physico-chemical analyses, staphylococcus aureus

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Authors: Madeline Phillips, Luis Mendez

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The 21st century has seen an increase in the amount and variety of psychological research on Latinx, the largest minority group in the U.S., with great variability from the individual’s cultural origin (e.g., ethnicity) to region (e.g., nationality). We were interested in exploring how scientists recruit, conduct and report research on Latinx samples. Ethnicity and race are important components of individuals and should be addressed to capture a broader and deeper understanding of psychological research findings. In order to explore Latinx/Hispanic work, the Journal of Latinx Psychology (JLP) and Hispanic Journal of Behavioral Sciences (HJBS) were analyzed for 1) measures of ethnicity and race in empirical studies 2) nationalities represented 3) how researchers reported ethnic-racial demographics. The analysis included publications from 2013-2018 and revealed two common themes of reporting ethnicity and race: overrepresentation/underrepresentation and overgeneralization. There is currently not a systematic way of reporting ethnicity and race among Latinx/Hispanic research, creating a vague sense of what and how ethnicity/race plays a role in the lives of participants. Second, studies used the Hispanic/Latinx terms interchangeably and are not consistent across publications. For the purpose of this project, we were only interested in publications with Latinx samples in the U.S. Therefore, studies outside of the U.S. and non-empirical studies were excluded. JLP went from N = 118 articles to N = 94 and HJBS went from N = 174 to N = 154. For this project, we developed a coding rubric for ethnicity/race that reflected the different ways researchers reported ethnicity and race and was compatible with the U.S. census. We coded which ethnicity/race was identified as the largest ethnic group in each sample. We used the ethnic-racial breakdown numbers or percentages if provided. There were also studies that simply did not report the ethnic composition besides Hispanic or Latinx. We found that in 80% of the samples, Mexicans are overrepresented compared to the population statistics of Latinx in the US. We observed all the ethnic-racial breakdowns, demonstrating the overrepresentation of Mexican samples and underrepresentation and/or lack of representation of certain ethnicities (e.g., Chilean, Guatemalan). Our results showed an overgeneralization of studies that cluster their participants to Latinx/Hispanic, 23 for JLP and 63 for HJBS. The authors discuss the importance of transparency from researchers in reporting the context of the sample, including country, state, neighborhood, and demographic variables that are relevant to the goals of the project, except when there may be an issue of privacy and/or confidentiality involved. In addition, the authors discuss the importance to recognize the variability within the Latinx population and how it is reflected in the scientific discourse.

Keywords: Latinx, Hispanic, race and ethnicity, diversity

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Authors: C. E. Sutton, A. Varvani-Farahani

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Fatigue damage and life prediction of particle metal matrix composites (PMMCs) under uniaxial and multiaxial loading conditions were investigated. Three PMM composite materials of Al6061/Al2O3/20p-T6, Al6061/Al2O3/22p-T6 and Al6061/SiC/17w-T6 tested under tensile, torsion, and combined tension-torsion fatigue cycling were evaluated with various fatigue damage models. The fatigue damage models of Smith-Watson-Topper (S. W. T.), Ellyin, Brown-Miller, Fatemi-Socie, and Varvani were compared for their capability to assess the fatigue damage of materials undergoing various loading conditions. Fatigue life predication results were then evaluated by implementing material-dependent coefficients that factored in the effects of the particle reinforcement in the earlier developed Varvani model. The critical plane-energy approach incorporated the critical plane as the plane of crack initiation and early stage of crack growth. The strain energy density was calculated on the critical plane incorporating stress and strain components acting on the plane. This approach successfully evaluated fatigue damage values versus fatigue lives within a narrower band for both uniaxial and multiaxial loading conditions as compared with other damage approaches studied in this paper.

Keywords: fatigue damage, life prediction, critical plane approach, energy approach, PMM composites

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Authors: Mania Nosratinia, Zahra Deris

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The purpose of the present study was to investigate the relationship between EFL learners' self-regulation (SR) and willingness to communicate (WTC). To this end, 520 male and female EFL learners, ranging between 19 and 34 years old (Mage = 26), majoring in English Translation, English Language Teaching and English Literature at Islamic Azad University, Fars Province, were randomly selected. They were given two questionnaires: Self-Regulation Questionnaire devised by Brown, Miller, and Lawendowski (1999) and Willingness to Communicate Scale devised by McCroskey and Baer (1985). Preliminarily, pertinent analyses were performed on the data to check the assumptions of normality, linearity, and homoscedasticity. Since the assumption of normality was violated, Spearman's rank-order correlation was employed to probe the relationships between SR and WTC. The results indicated a significant and positive correlation between the two variables, ρ = .56, n = 520, p < .05, which signified a large effect size supplemented by a very small confidence interval (0.503 – 0.619). The results of the Kruskal-Wallis tests indicated that there is a statistically significant difference in WTC score between the different levels of SR, χ2(2) = 157.843, p = 0.000 with a mean rank SR score of 128.13 for low-SR level, 286.64 for mid-SR level, and 341.12 for high-SR level. Also, a post-hoc comparison through running a Dwass-Steel-Critchlow-Fligner indicated significant differences among the SR level groups on WTC scores. Given the findings of the study, the obtained results may help EFL teachers, teacher trainers, and material developers to possess a broader perspective towards the TEFL practice and to take practical steps towards the attainments of the desired objectives and effective instruction.

Keywords: EFL learner, self-regulation, willingness to communicate, relationship

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Authors: Jacqueline Miller, Dongyuan Y. Wang, F. Dan Richard

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Before trying to make an ethical machine that holds a higher ethical standard than humans, a better understanding of human moral standards that could be used as a guide is crucial. How humans make decisions in dangerous driving situations like moral dilemmas can contribute to developing acceptable ethical principles for autonomous vehicles (AVs). This study uses a driving simulator to investigate whether drivers make utilitarian choices (choices that maximize lives saved and minimize harm) in unavoidable automobile accidents (moral dilemmas) with time pressure manipulated. This study also investigates how impulsiveness influences drivers’ behavior in moral dilemmas. Manipulating time pressure results in collisions that occur at varying time intervals (4 s, 5 s, 7s). Manipulating time pressure helps investigate how time pressure may influence drivers’ response behavior. Thirty-one undergraduates participated in this study using a STISM driving simulator to respond to driving moral dilemmas. The results indicated that the percentage of utilitarian choices generally increased when given more time to respond (from 4 s to 7 s). Additionally, participants in vehicle scenarios preferred responding right over responding left. Impulsiveness did not influence utilitarian choices. However, as time pressure decreased, response time increased. Findings have potential implications and applications on the regulation of driver assistance technologies and AVs.

Keywords: time pressure, automobile moral dilemmas, impulsiveness, reaction time

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Authors: Lauren M. McKinnon, Justin B. Miller, Michael F. Whiting, John S. K. Kauwe, Perry G. Ridge

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Background: Ramp sequences increase translational speed and accuracy when rare, slowly-translated codons are found at the beginnings of genes. Here, the results of the first analysis of ramp sequences in a phylogenetic construct are presented. Methods: Ramp sequences were compared from 211 vertebrates (110 Mammalian and 101 non-mammalian). The presence and absence of ramp sequences were analyzed as a binary character in a parsimony and maximum likelihood framework. Additionally, ramp sequences were mapped to the Open Tree of Life taxonomy to determine the number of parallelisms and reversals that occurred, and these results were compared to what would be expected due to random chance. Lastly, aligned nucleotides in ramp sequences were compared to the rest of the sequence in order to examine possible differences in phylogenetic signal between these regions of the gene. Results: Parsimony and maximum likelihood analyses of the presence/absence of ramp sequences recovered phylogenies that are highly congruent with established phylogenies. Additionally, the retention index of ramp sequences is significantly higher than would be expected due to random chance (p-value = 0). A chi-square analysis of completely orthologous ramp sequences resulted in a p-value of approximately zero as compared to random chance. Discussion: Ramp sequences recover comparable phylogenies as other phylogenomic methods. Although not all ramp sequences appear to have a phylogenetic signal, more ramp sequences track speciation than expected by random chance. Therefore, ramp sequences may be used in conjunction with other phylogenomic approaches.

Keywords: codon usage bias, phylogenetics, phylogenomics, ramp sequence

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Colorectal cancer (CRC) is usually managed with surgical resection. Many of the outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO), such as Health-Related Quality of life (HRQoL), provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. HRQoL has previously been shown to be impacted by psychosocial, behavioral and disease-specific characteristics. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods: Consecutive patients who had resection of colorectal cancer in a single regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey instrument designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Demographic and disease-specific data were also collected via medical record review. Results: Forty-six patients completed the survey. Clinically significant levels of fear of recurrence as well as emotional distress, were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for CRC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL; however, the operative approach (laparoscopic vs. open) was associated with HRQoL for these patients. All psychosocial factors measured were associated with HRQoL, including cancer worry, emotional distress, body image and dispositional optimism. Conclusion: HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative colorectal cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.

Keywords: surgery, colorectal, cancer, PRO, HRQoL

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Authors: Wynne De Jong, Robert Miller, Ross Riggs

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Beyond the number of nurses providing care for patients, having nurses with the right skills, experience and education is essential to ensure the best possible outcomes for patients. Research studies continue to link nurse staffing and skill mix with nurse-sensitive patient outcomes; numerous studies clearly show that superior patient outcomes are associated with higher levels of regulated staff. Due to the limited number of tools and processes available to assist nurse leaders with staffing models of care, nurse leaders are constantly faced with the ongoing challenge to ensure their staffing models of care best suit their patient population. In 2009, several hospitals in Ontario, Canada participated in a research study to develop and evaluate an RN/RPN utilization toolkit. The purpose of this study was to develop and evaluate a toolkit for Registered Nurses/Registered Practical Nurses Staff mix decision-making based on the College of Nurses of Ontario, Canada practice standards for the utilization of RNs and RPNs. This paper will highlight how an organization has further developed the Patient Care Needs Assessment (PCNA) questionnaire, a major component of the toolkit. Moreover, it will demonstrate how it has utilized the information from PCNA to clearly identify patient and family care needs, thus providing evidence-based results to assist leaders with matching the best staffing skill mix to their patients.

Keywords: nurse staffing models of care, skill mix, nursing health human resources, patient safety

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Authors: Jessica Hemberg, Mikaela Miller

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Unreasonable workload and work-related stress can reduce nurse leaders’ job satisfaction and productivity and can increase absence and burnout. Nurse leaders’ workload in public healthcare settings is relatively unresearched. The aim of this study was to investigate nurse leaders’ perceptions of workload and task distribution with relation to leading work tasks in public healthcare. A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N=8). The method was inspired by content analysis. The COREQ checklist was used. Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload, and Insufficient time for leadership mission. The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organizing more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders’ workload. Future research should focus on investigating workload and task distribution from nurses’ perspectives.

Keywords: nurse leaders, workload, task distribution, public healthcare, qualitative

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

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Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: B. J. Mahen, N. E. Lloyd-Gale, S. Johnson, W. P. Rakowicz, M. J. Harris, A. D. Miller

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Background: Migraine is a leading cause of disability in the world. Calcitonin gene-related peptide (CGRP) receptor antagonists offer an approach to migraine prophylaxis by inhibiting the inflammatory and vasodilatory effects of CGRP. In recent years, NICE licensed the use of three CGRP-receptor antagonists: Fremanezumab, Galcanezumab, and Erenumab. Here, we present the outcomes of CGRP-antagonist treatment in a cohort of patients who suffer from episodic or chronic migraine and have failed at least three oral prophylactic therapies. Methods: We offered CGRP antagonists to 86 patients who met the NICE criteria to start therapy. We recorded the number of headache days per month (HDPM) at 0 weeks, 3 months, and 12 months. Of those, 26 patients were switched to an alternative treatment due to poor response or side effects. Of the 112 total cases, 9 cases did not sufficiently maintain their headache diary, and 5 cases were not followed up at 3 months. We have therefore included 98 sets of data in our analysis. Results: Fremanezumab achieved a reduction in HDPM by 51.7% at 3 months (p<0.0001), with 63.7% of patients meeting NICE criteria to continue therapy. Patients trialed on Galcanezumab attained a reduction in HDPM by 47.0% (p=0.0019), with 51.6% of patients meeting NICE criteria to continue therapy. Erenumab, however, only achieved a reduction in HDPM by 17.0% (p=0.29), and this was not statistically significant. Furthermore, 34.4%, 9.7%, and 4.9% of patients taking Fremanezumab, Galcanezumab, and Erenumab, respectively, continued therapy beyond 12 months. Of those who attempted drug holidays following 12 months of treatment, migraine symptoms relapsed in 100% of cases. Conclusion: We observed a significant improvement in HDPM amongst episodic and chronic migraine patients following treatment with Fremanezumab or Galcanezumab.

Keywords: migraine, CGRP, fremanezumab, galcanezumab, erenumab

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Authors: Meghan Biallas, Amanda Hoffman, Tamara Miller, Kimmy Schnibben, Janaina Siegler

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This paper assesses Walmart’s supply chain resiliency amidst continuous supply chain disruptions. It aims to evaluate how Walmart can use supply chain resiliency theory to retain its status as a global supply chain leader. The Bloomberg terminal was used to organize Walmart’s 754 Tier-1 suppliers by the size of their relationship to Walmart. Additional data from IBISWorld and Statista was also used in the analysis. This research focused on the top ten Tier-1 suppliers, with the greatest percentage of their revenue attributed to Walmart. This paper also applied the firm’s information to the Supply Chain Resilience Assessment and Management (SCRAM) framework for supply chain resiliency to evaluate the firm’s capabilities, vulnerabilities, and gaps. A rubric was created to quantify Walmart’s risks using four pillars: flexibility, velocity, visibility, and collaboration. Information and examples were reported from Walmart’s 10k filing. For each example, a rating of 1 indicated “high” resiliency, 0 indicated “medium” resiliency, and -1 indicated “low” resiliency. Findings from this study include the following: (1) Walmart has maintained its leadership through its ability to remain resilient with regard to visibility, efficiency, capacity, and collaboration. (2) Walmart is experiencing increases in supply chain costs due to internal factors affecting the company and external factors affecting its suppliers. (3) There are a number of emerging supply chain risks with Walmart’s suppliers, which could cause issues for Walmart to remain a supply chain leader in the future. Using the SCRAM framework, this paper assesses how Walmart measures up to the Supply Chain Resiliency Theory, identifying areas of strength as well as areas where Walmart can improve in order to remain a global supply chain leader.

Keywords: supply chain resiliency, zone of balanced resilience, supply chain resilience assessment and management, supply chain theory.

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Authors: Suraj Amrutkar, R. Gowri, Asma Khan, Nazam Khan, Vikas Mahajan, Manpreet Kour And Bharti Deshmukh

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Herbal additives are rich in vitamin C, A and other biological active compounds and may act as surrogate source to subdue heat stress in chicken. Among various herbal additives such as rough lemon (Citrus Jambhiri Lush) juice, amla (Emblica officinalis) juice and aloe vera (Aloe barbadensis miller) gel are easily available during summer (stress period) and also cost less as comparison to synthetic feed additives in market. In order to analyze the performance by supplementation of rough lemon juice, amla juice and aloe vera gel in broiler under heat stress conditions. Study was carried out with a random distribution of day old straight run chicks (240 No.) in to four treatment group (n=60) was done. All the groups were given basal diet (Maize-Soya based; T0) was same for all the groups with supplementation of rough lemon juice (T1), amla juice (T2) and aloe vera (T3) @ 2% in drinking water. Experiment trial lasted for 42 days during heat stress period (June-July) with minimum THI (78.2) and Maximum THI (88.02). Feed and water were offered ad-libitum throughout the trial. Results revealed significantly higher (P<0.05) body weight in T3 and T2, followed by T1 and least in T0 at 42 days of age. The overall mean of Feed conversion ratio of various treatment T0, T1, T2 andT3 were 2.16, 1.98, 1.89 and 1.82, respectively. The mortality percentage in various treatment, T0, T1, T2 and T3, were 6.67, 3.33, 0.0 and 1.67, respectively. pH value, PCV (%), Sodium (mmol/L) and Potassium (mmol/L) was higher in T3 than rest of the groups. HL ratio is significantly lower (P<0.05) in T3, T2 followed by T1 than T0 at 42 days of age. It may be inferred that amongst these phyto-additives, aloe vera leads in alleviating heat stress in broiler in an economical way, followed by amla and rough lemon.

Keywords: rough lemon, amla, aloe vera, heat stress, broiler

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Authors: Lesly Y Carmona-Sarabia, Luisa Barraza-Vergara, Vilmalí López-Mejías, Wandaliz Torres-García, Maribella Domenech-Garcia, Madeline Torres-Lugo

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Biosensors are used in many applications providing real-time monitoring to treat long-term conditions. Thus, understanding the physicochemical properties and biological side effects on the skin of polymers (e. g., poly(methyl methacrylate), PMMA) employed in the fabrication of wearable biosensors is crucial for the selection of manufacturing materials within this field. The PMMA (hydrophobic and thermoplastic polymer) is commonly employed as a coating material or substrate in the fabrication of wearable devices. The cytotoxicityof PMMA (including residual monomers or degradation products) on the skin, in terms of cells and tissue, is required to prevent possible adverse effects (cell death, skin reactions, sensitization) on human health. Within this work, accelerated aging of PMMA (Mw ~ 15000) through thermal and photochemical degradation was under-taken. The accelerated aging of PMMA was carried out by thermal (200°C, 1h) and photochemical degradation (UV-Vis, 8-15d) adapted employing ISO protocols (ISO-10993-12, ISO-4892-1:2016, ISO-877-1:2009, ISO-188: 2011). In addition, in vitro cytotoxicity evaluation of PMMA degradation products was performed using NIH3T3 fibroblast cells to assess the response of skin tissues (in terms of cell viability) exposed with polymers utilized to manufacture wearable biosensors, such as PMMA. The PMMA (Mw ~ 15000) before and after accelerated aging experiments was characterized by thermal gravimetric analysis (TGA), differential scanning calorimetric (DSC), powder X-ray diffractogram (PXRD), and scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) to determine and verify the successful degradation of this polymer under the specific conditions previously mention. The degradation products were characterized through nuclear magnetic resonance (NMR) to identify possible byproducts generated after the accelerated aging. Results demonstrated a percentage (%) weight loss between 1.5-2.2% (TGA thermographs) for PMMA after accelerated aging. The EDS elemental analysis reveals a 1.32 wt.% loss of carbon for PMMA after thermal degradation. These results might be associated with the amount (%) of PMMA degrade after the accelerated aging experiments. Furthermore, from the thermal degradation products was detected the presence of the monomer and methyl formate (low concentrations) and a low molecular weight radical (·COOCH3) in higher concentrations by NMR. In the photodegradation products, methyl formate was detected in higher concentrations. These results agree with the proposed thermal or photochemical degradation mechanisms found in the literature.1,2 Finally, significant cytotoxicity on the NIH3T3 cells was obtained for the thermal and photochemical degradation products. A decrease in cell viability by > 90% (stock solutions) was observed. It is proposed that the presence of byproducts (e.g. methyl formate or radicals such as ·COOCH₃) from the PMMA degradation might be responsible for the cytotoxicity observed in the NIH3T3 fibroblast cells. Additionally, experiments using skin models will be employed to compare with the NIH3T3 fibroblast cells model.

Keywords: biosensors, polymer, skin irritation, degradation products, cell viability

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Authors: Briony Gray, Glenn Simpson, Hajira Dambha-Miller, Andrew Farmer

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Multimorbidity may be strongly affected by a variety of conditions, factors, and variables requiring higher demands on health and social care services, infrastructure, and expenses. Holding one or more conditions increases one’s risk for development of future conditions; with patients over 65 years old at highest risk. Psychosocial factors such as anxiety and depression are rising exponentially globally, which has been amplified by the COVID19 pandemic. These are highly correlated and predict poorer outcomes when held in coexistence and increase the likelihood of comorbid physical health conditions. While possible future reform of social and healthcare systems may help to alleviate some of these mounting pressures, there remains an urgent need to better understand the potential role health behaviours and psychosocial conditions - such as anxiety and depression – may have on aging populations. Using the UK healthcare scene as a lens for analysis, this study uses big data collected in the UK Longitudinal Study of Aging (ELSA) to examine the role of anxiety and depression in ageing populations (65yrs+). Using logistic regression modelling, results identify the 10 most significant variables correlated with both anxiety and depression from data categorised into the areas of health behaviour, psychosocial, socioeconomic, and life satisfaction (each demonstrated through literature review to be of significance). These are compared with wider global research findings with the aim of better understanding the areas in which social and healthcare reform can support multimorbidity interventions, making suggestions for improved patient-centred care. Scope of future research is outlined, which includes analysis of 59 total multimorbidity variables from the ELSA dataset, going beyond anxiety and depression.

Keywords: multimorbidity, health behaviours, patient centred care, psychosocial factors

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Authors: Telma Fontao de Castro, Kylee Miller, Maria Xavier Araújo, Isabel Brandao, Sandra Torres

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Objective: There is a dearth of research investigating the long-term emotional functioning of individuals recovered from anorexia nervosa (AN). This 15-year longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term AN recovery and its link to anxiety and depression. Method: Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, and emotion regulation difficulties (ER; only assessed in recovery phase). Results: Anxiety, depression, and alexithymia levels decreased significantly with AN recovery. However, scores on anxiety and difficulty in identifying feelings (alexithymia factor) remained high when compared to the HC group. Scores on emotion regulation difficulties were also lower in HC group. The abovementioned differences between AN recovered group and HC group in difficulties in identifying and accepting feelings and lack of emotional clarity were no longer present when the effect of anxiety and depression was controlled. Conclusions: Findings suggest that emotional dysfunction tends to decrease in AN recovered phase. However, using an HC group as a reference, we conclude that several emotional difficulties are still increased after long-term AN recovery, in particular, limited access to emotion regulation strategies, and difficulty controlling impulses and engaging in goal-directed behavior, thus suggesting to be a trait vulnerability. In turn, competencies related to emotional clarity and acceptance of emotional responses seem to be state-dependent phenomena linked to anxiety and depression. In sum, managing emotions remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behavior can serve as an affect regulatory function, increasing the risk of relapse. Emotional education and stabilization of depressive and anxious symptomatology after recovery emerge as an important avenue to protect from long-term AN relapse.

Keywords: alexithymia, anorexia nervosa, emotion recognition, emotion regulation

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Authors: Naridchaya Aberdour, Joanna Kao, Anne Miller, Timothy Shore, Richard Maher, Zhixin Liu

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Background: COVID-19 has and continues to be a strain on healthcare globally, with the number of patients requiring hospitalization exceeding the level of medical support available in many countries. As chest x-rays are the primary respiratory radiological investigation, the Radiological Assessment of Lung Edema (RALE) score was used to quantify the extent of pulmonary infection on baseline imaging. Assessment of RALE score's reproducibility and associations with clinical outcome parameters were then evaluated to determine implications for patient management and prognosis. Methods: A retrospective study was performed with the inclusion of patients testing positive for COVID-19 on nasopharyngeal swab within a single Local Health District in Sydney, Australia and baseline x-ray imaging acquired between January to June 2020. Two independent Radiologists viewed the studies and calculated the RALE scores. Clinical outcome parameters were collected and statistical analysis was performed to assess RALE score reproducibility and possible associations with clinical outcomes. Results: A total of 78 patients met inclusion criteria with the age range of 4 to 91 years old. RALE score concordance between the two independent Radiologists was excellent (interclass correlation coefficient = 0.93, 95% CI = 0.88-0.95, p<0.005). Binomial logistics regression identified a positive correlation with hospital admission (1.87 OR, 95% CI= 1.3-2.6, p<0.005), oxygen requirement (1.48 OR, 95% CI= 1.2-1.8, p<0.005) and invasive ventilation (1.2 OR, 95% CI= 1.0-1.3, p<0.005) for each 1-point increase in RALE score. For each one year increased in age, there was a negative correlation with recovery (0.05 OR, 95% CI= 0.92-1.0, p<0.01). RALE scores above three were positively associated with hospitalization (Youden Index 0.61, sensitivity 0.73, specificity 0.89) and above six were positively associated with ICU admission (Youden Index 0.67, sensitivity 0.91, specificity 0.78). Conclusion: The RALE score can be used as a surrogate to quantify the extent of COVID-19 infection and has an excellent inter-observer agreement. The RALE score could be used to prognosticate and identify patients at high risk of deterioration. Threshold values may also be applied to predict the likelihood of hospital and ICU admission.

Keywords: chest radiography, coronavirus, COVID-19, RALE score

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Authors: Jun Ying Lin, Tzu Hsiang Yen, Cha'o Kuang Chen

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Nowadays, the great majority believe that there is great potentiality in hydrogen storage alloy storing hydrogen by physical and chemical absorption. However, the hydrogen storage alloy is limited by high operation temperature. Scientists find that adding transition elements can improve the properties of hydrogen storage alloy. In this research, outstanding improvements of kinetic and thermal properties are given by the addition of Palladium and Titanium hydride to Magnesium-based hydrogen storage alloy. Magnesium-based alloy is the main material, into which TiH2 / Pd are added separately. Following that, materials are milled by a Planetary Ball Miller at 650 rpm. TGA/DSC and PCT measure the capacity, spending time and temperature of abs/des-orption. Additionally, SEM and XRD analyze the structures and components of material. It is clearly shown that Pd is beneficial to kinetic properties. 2MgH2-0.1Pd has the highest capacity of all the alloys listed, approximately 5.5 wt%. Secondly, there are not any new Ti-related compounds found from XRD analysis. Thus, TiH2, considered as the catalyst, leads to the condition of 2MgH2-TiH2 and 2MgH2-TiH2-0.1Pd efficiently absorbing hydrogen in low temperature. 2MgH2-TiH2 can reach roughly 3.0 wt% in 82.4 minutes at 50°C and 8 minutes at 100°C, while2MgH2-TiH2-0.1Pd can reach 2.0 wt% in 400 minutes at 50°C and in 48 minutes at 100°C. The lowest temperature of 2MgH2-0.1Pd and 2MgH2-TiH2 is similar (320°C), otherwise the lowest temperature of 2MgH2-TiH2-0.1Pd decrease by 20°C. From XRD, it can be observed that PdTi2 and Pd3Ti are produced by mechanical alloying when adding Pd as well as TiH2 into MgH2. Due to the synergistic effects between Pd and TiH2, 2MgH2-TiH2-0.1Pd owns the lowest dehydrogenation temperature. Furthermore, the Pressure-Composition-Temperature (PCT) curve of 2MgH2-TiH2-0.1Pd is measured at different temperature, 370°C, 350°C, 320°C and 300°C separately. The plateau pressure is given form the PCT curves above. In accordance to different plateau pressures, enthalpy and entropy in the Van’t Hoff equation can be solved. In 2MgH2-TiH2-0.1Pd, the enthalpy is 74.9 KJ/mol and the entropy is 122.9 J/mol. Activation means that hydrogen storage alloy undergoes repeat abs/des-orpting processes. It plays an important role in the abs/des-orption. Activation shortens the abs/des-orption time because of the increase in surface area. From SEM, it is clear that the grain size and surface become smaller and rougher

Keywords: hydrogen storage materials, magnesium hydride, abs-/des-orption performance, Plateau pressure

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Authors: Malcolm Dinovitzer, Calvin Miller, Adam Hacker, Gabriel Wong, Zach Annen, Padmassun Rajakareyar, Jordan Mulvihill, Mostafa S.A. ElSayed

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The research work presented in this paper is developed by the Blended Wing Body (BWB) Unmanned Aerial Vehicle (UAV) team, a fourth-year capstone project at Carleton University Department of Mechanical and Aerospace Engineering. Here, a clean sheet UAV with BWB configuration is designed and optimized using Multiscale Design Optimization (MSDO) approach employing lattice materials taking into consideration design for additive manufacturing constraints. The BWB-UAV is being developed with a mission profile designed for surveillance purposes with a minimum payload of 1000 grams. To demonstrate the design methodology, a single design loop of a sample rib from the airframe is shown in details. This includes presentation of the conceptual design, materials selection, experimental characterization and residual thermal stress distribution analysis of additively manufactured materials, manufacturing constraint identification, critical loads computations, stress analysis and design optimization. A dynamic turbulent critical load case was identified composed of a 1-g static maneuver with an incremental Power Spectral Density (PSD) gust which was used as a deterministic design load case for the design optimization. 2D flat plate Doublet Lattice Method (DLM) was used to simulate aerodynamics in the aeroelastic analysis. The aerodynamic results were verified versus a 3D CFD analysis applying Spalart-Allmaras and SST k-omega turbulence to the rigid UAV and vortex lattice method applied in the OpenVSP environment. Design optimization of a single rib was conducted using topology optimization as well as MSDO. Compared to a solid rib, weight savings of 36.44% and 59.65% were obtained for the topology optimization and the MSDO, respectively. These results suggest that MSDO is an acceptable alternative to topology optimization in weight critical applications while preserving the functional requirements.

Keywords: blended wing body, multiscale design optimization, additive manufacturing, unmanned aerial vehicle

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Authors: Badawia Ibrahim, Iman Hussein, Samar El Sheikh, Fatma Abou Elkasem, Hazem Abo Ismael

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Background: Response of breast carcinoma to neoadjuvant chemotherapy (NAC) varies regarding many factors including hormonal receptor status. Breast cancer is a heterogenous disease with different outcomes, hence a need arises for new markers predicting the outcome of NAC especially for the triple negative group when estrogen, progesterone receptors and Her2/neu are negative. FOXP3 is a promising target with unclear role. Aim: To examine the value of FOXP3 expression in locally advanced triple negative breast cancer tumoral cells as well as tumor infiltrating lymphocytes (TILs) and to elucidate its relation to the extent of NAC response. Material and Methods: Forty five cases of immunohistochemically confirmed to be triple negative breast carcinoma were evaluated for NAC (Doxorubicin, Cyclophosphamide AC x 4 cycles + Paclitaxel x 12 weeks, patients with ejection fraction less than 60% received Taxotere or Cyclophosphamide, Methotrexate, Fluorouracil CMF) response in both tumour and lymph nodes status according to Miller & Payne's and Sataloff's systems. FOXP3 expression in tumor as well as TILs evaluated in the pretherapy biopsies was correlated with NAC response in breast tumor and lymph nodes as well as other clinicopathological factors. Results: Breast tumour cells showed FOXP3 positive cytoplasmic expression in (42%) of cases. High FOXP3 expression percentage was detected in (47%) of cases. High infiltration by FOXP3+TILs was detected in (49%) of cases. Positive FOXP3 expression was associated with negative lymph node metastasis. High FOXP3 expression percentage and high infiltration by FOXP3+TILs were significantly associated with complete therapy response in axillary lymph nodes. High FOXP3 expression in tumour cells was associated with high infiltration by FOXP3+TILs. Conclusion: This result may provide evidence that FOXP3 marker is a good prognostic and predictive marker for triple negative breast cancer (TNBC) indicated for neoadjuvant chemotherapy and can be used for stratifications of TNBC cases indicated for NAC. As well, this study confirmed the fact that the tumour cells and the surrounding microenvironment interact with each other and the tumour microenvironment can influence the treatment outcomes of TNBC.

Keywords: breast cancer, FOXP3 expression, prediction of neoadjuvant chemotherapy effect, triple negative

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Authors: Peter Park, Alfonso Ayala, Douglas Saeks, Jordan Miller, Carmen Flores, Karen Nelson

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Introduction Hip fractures account for more than 300,000 hospital admissions every year. Many present as fragility fractures in geriatric patients with multiple medical comorbidities. Standardized protocols for the multidisciplinary management of this patient population have been shown to improve patient outcomes. A hip fracture protocol was implemented at a Level I Trauma center with a focus on pre-operative medical optimization and early surgical care. This study evaluates the efficacy of that protocol, including the early transition period. Methods A retrospective review was performed of all patients ages 60 and older with isolated hip fractures who were managed surgically between 2020 and 2022. This included patients 1 year prior and 1 year following the implementation of a hip fracture protocol at a Level I Trauma center. Results 530 patients were identified: 249 patients were treated before, and 281 patients were treated after the protocol was instituted. There was no difference in mean age (p=0.35), gender (p=0.3), or Charlson Comorbidity Index (p=0.38) between the cohorts. Following the implementation of the protocol, there were observed increases in time to surgery (27.5h vs. 33.8h, p=0.01), hospital length of stay (6.3d vs. 9.7d, p<0.001), and ED LOS (5.1h vs. 6.2h, p<0.001). There were no differences in in-hospital mortality (2.01% pre vs. 3.20% post, p=0.39) and complication rates (25% pre vs 26% post, p=0.76). A trend towards improved outcomes was seen after the early transition period but failed to yield statistical significance. Conclusion Early medical management and surgical intervention are key determining factors affecting outcomes following fragility hip fractures. The implementation of a hip fracture protocol at this institution has not yet significantly affected these parameters. This could in part be due to the restrictions placed at this institution during the COVID-19 pandemic. Despite this, the time to OR pre-and post-implementation was quicker than figures reported elsewhere in literature. Further longitudinal data will be collected to determine the final influence of this protocol. Significance/Clinical Relevance Given the increasing number of elderly people and the high morbidity and mortality associated with hip fractures in this population finding cost effective ways to improve outcomes in the management of these injuries has the potential to have enormous positive impact for both patients and hospital systems.

Keywords: hip fracture, geriatric, treatment algorithm, preoperative optimization

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