Patients with limited health literacy often fail to understand verbal and written discharge instructions, and they frequently return to the emergency department (ED) for care. Patients returning to the ED and 30-day readmission rate are core quality performance measures. The purpose of this project was to decrease repeat visits and readmissions to the ED by implementing components of health literacy programs within the ED on patient education and written discharge instructions. Change implementation consisted of (a) use of teach back method (b) modifying medical terminology to language that patient could understand (c) limiting use of words with more than three syllables and (d) discouraging nursing practice of copying and pasting other completed clinician notes in discharge notes. Following the tenets of the logic model and Watson's caring theory, ED nurses (n=45) at a veteran's healthcare facility participated in the modification of the ED discharge note design. A retrospective quantitative design was used to obtain data from 5,474 records related to each patient's language preference, educational level, and the readability index of the discharge note pre-and post-modification of the note. The comparative analysis of the descriptive statistics before and after modification of the discharge note indicated a decrease of 1.75% in the readability index of the discharge note, a 24% decrease in return visits within 30 days and a 40% decrease in readmission rate within 30 days. Healthcare costs and health disparities associated with health literacy decrease if patients comprehend discharge instructions. Understanding verbal and written discharge instructions correlates with healthy communities. Health literacy policies and technological innovation can promote health literacy and research on health literacy.

Syftet med studien är att undersöka transspråkande i svenskämnets skrivundervisning i årskurs 4–6 utifrån ett lärarperspektiv. För att besvara studiens syfte och frågeställningar har systematiska observationer och semistrukturerade intervjuer genomförts. Observationerna genomfördes i fyra olika klassrum där transspråkande tillämpades i skrivundervisningen och sedan genomfördes fyra intervjuer med undervisande lärare. Studien utgår från den sociokulturella teorin i samband med teorin om transspråkande och de teorispecifika begreppen mediering och proximal utvecklingszon. Studiens resultat visar bland annat att framgångsrika arbetssätt med transspråkande i skrivandet är muntliga, textbaserade samt visuella arbetssätt. De medverkande lärarnas uppfattningar om transspråkande i skrivundervisningen är att det verkar som identitetsstärkande för flerspråkiga elever och att det ökar elevernas förståelse för det svenska språket. Lärarna anser dock att tidsbristen och känslan av otillräcklighet är de största problemen med ämnet.

English has been on the rise on the global stage for the last half century, and is now the most studied second language, being used regularly in international academia, social and mainstream media and international relations. In Sweden, the increase in the use of English is particularly noticeable in the country’s higher education system, with recent studies reporting a significant increase in English as the language of instruction. Although Sweden has a generally high proficiency in English, recent reports show a number of students feel insecure in using English at universities. A possible pedagogical method to address students' uncertainty is Content and Language Integrated Learning (CLIL). While there is much research regarding CLIL, the research is divided on its efficacy best practices, and research is limited in the Swedish context. Thus, the purpose of this study is to investigate the beliefs and practices of CLIL among upper secondary English teachers in Sweden in order to add to the body of knowledge surrounding CLIL use, especially in the Swedish context. Data collection was done with a survey sent out to 260 schools in Sweden. The results of the study are limited in scope and depth due to very low response rates (n=8), but tentative conclusions may be drawn from it that support earlier findings, such as the importance of certain contextual factors in the school. The study concludes that CLIL is indeed an appreciated tool among the teachers asked, and that any teacher who is considering using it should ensure that the school environment is one that facilitates CLIL rather than hinders it.

Små och medelstora företag med bristande ekonomiska förutsättningar brukar ha problem med att standardisera sitt arbete samt minska sina slöserier på grund av uppdaterade arbetsinstruktioner, en oorganiserad arbetsmiljö och produktionsprocessen. 5S är ett leanverktyg som kan implementeras i syfte att förbättra produktionsprocessen och arbetsmiljön samt reducera slöserier. Implementering av 5S leder även till ökad produktivitet och effektivitet i produktionen. Många SME företag har problem med att implementera 5S eftersom det är en metod som behöver anpassas specifikt till varje företags olika förutsättningar. Välutformade arbetsinstruktioner är ett bra sätt att standardisera sitt arbete men i nuläget är de flesta SME företag oenade om i vilken media arbetsinstruktionerna ska vara utformade i. I dagsläget är pappersinstruktioner den dominanta varianten bland SME företag. Med tanke på att digitalisering ökar inom företag bör man utforska möjligheterna med digitala arbetsinstruktioner. Syftet med arbetet är att utföra en undersökning på hur arbetsinstruktioner ska vara utformade samt en implementering av lean verktyget 5S för ett effektivt och standardiserat arbetssätt. Med utformningen av arbetsinstruktionerna menas specifikt i vilken media arbetsinstruktionerna ska utformas i för att uppfylla målet. För att uppnå syftet utformades samt tillämpades pappers- och digitala arbetsinstruktioner i företaget Conflux AB. En litteraturstudie utfördes i syfte att få en djupare förståelse inom implementationer av 5S. Sedan implementerades 5S tillsammans med produktionschefen och operatörerna i företaget för att försöka minska slöserier samt öka effektiviteten. Resultatet av detta arbete visade att implementationen av 5S och välutformade arbetsinstruktioner ledde till en förbättrad arbetsmiljö, ökad effektivitet och produktivitet samt minskade slöserier enligt intervjuerna med operatörerna som tog plats hos Conflux AB. Vidare förklarade operatörerna att arbetsinstruktionen i papper föredrogs över den digitala arbetsinstruktionen. Detta på grund av att pappersinstruktionen var lättillgänglig och tydlig med tanke på den detaljerade nivån. Dessutom saknade företaget utrustning för att kunna utnyttja den digitala arbetsinstruktionen till dess fulla potential. Förbättringsförslagen som togs fram var bland annat att testa olika kombinationer av placering av maskiner i produktionen. Ett annat förbättringsförslag som togs fram var inköp av utrustning för användning av den digitala arbetsinstruktionen. / Small and medium companies with insufficient financial conditions often struggle with standardizing their work and reducing waste due to outdated work instructions, disorganized work environment, and production flow. 5S is a lean tool that can be implemented to organize the production flow and work environment, as well as reduce waste. Implementing 5S also leads to increased productivity and efficiency in production. Many SME companies face challenges in implementing 5S because it is a method that needs to be tailored specifically to each company's different conditions. Well-designed work instructions are a good way to standardize work, but currently, most SME companies are unsure about the medium in which work instructions should be designed. Currently, paper instructions are the dominant variant among SME companies. Considering the increasing digitization within companies, it is worth exploring the possibilities of digital work instructions. The purpose of this work is to conduct a study on how work instructions should be designed and to implement the lean tool 5S for an efficient and standardized work approach. The design of work instructions specifically refers to the medium in which work instructions should be designed to achieve the goal. To achieve the purpose, both paper and digital work instructions were designed and applied in the company Conflux AB. A literature study was conducted to gain a deeper understanding of 5S implementations. Subsequently, 5S was implemented together with the production manager and operators in the company in an effort to reduce waste and increase efficiency. The results of this work showed that the implementation of 5S and well-designed work instructions led to an improved work environment, increased efficiency and productivity, as well as reduced waste, according to the interviews with the operators at Conflux AB. Furthermore, the operators explained that they preferred the paper instructions over the digital work instructions. This was because the paper instructions were easily accessible and clear, especially in terms of detail. Additionally, the company lacked the necessary equipment to fully utilize the digital work instructions. Improvement suggestions that were developed included testing different combinations of machine placements in the production flow. Another improvement suggestion was the procurement of equipment to enable the use of the digital work instructions to their full potential.

83 The Limits of subordination of employee during dependant work Abstract An employment relationship is one of a civil law relationships. It differs from other civil law relationships because of its object, i.e. a dependant work and unequal positions of its subjects. At the time of commencement of the employment relationship, an employee becomes subordinate to an employer and the employee obliges to follow the instructions of the employer. The employee spends substantial part of his or her working day in this unequal relationship. Superordinate position of the employer is not absolute. In the history of the Czech labour law, we can see attempts to express this limitation of superordinate position of the employers. For example, the draft of the civil code from 1996 declares that an employee can refuse to perform the instruction of an employer which is not in compliance with the employment contract or the collective agreement and that an employee shall refuse to perform the task which is not in compliance with law. However, the act No. 262/2006 Sb., labour code, only declares that an employee shall perform instructions of an employer if they are made in compliance with law. Such absence of regulation shall not be interpreted in the way that a scope of the superordinate position of the employer is not limited....

The Sixth Amendment of the U.S. Constitution guarantees individuals’ right to trial by an impartial jury. However, empirical research indicates that the jury system is flawed, especially regarding judicial sentencing instructions. More specifically, jurors frequently misunderstand or misinterpret State patterned instructions. On a more encouraging note, there is evidence that comprehension of jury instructions can be improved. Thus, this research assessed improvement in juror comprehension using revised sentencing instructions. For the current investigation, participants included 201 volunteers called for jury duty in Western Tennessee. Data were generated via a questionnaire, which allowed for the collection of information relating to participants’ understanding of the sentencing instructions. Findings suggest that comprehension is low when jurors are only exposed to instructions written by the State. Furthermore, when jurors were given a more detailed explanation of certain problematic terminology, comprehension significantly increased. Policy implications of this research and directions for future improvement are discussed.

Background AR technology has been increasing across domains in cognitive activities, i.e. learning. Although there are studies that try to examine the quality AR can bring into different territories of human culture, such as educational settings, few studies aspire to determine how AR can have on human memory. Particularly short-term memory. Objectives This research aims to assess the affect on short-term memory through an AR and Analog game. Methods The method proposed for this thesis work is a user study in a controlled environment to gather data for the results. In order to test the hypothesis, a quantitative approach was selected as two versions of the same game were compared. A within-participant experiment was designed. Results The results from the experiment indicate that AR has a lower score on average compared to its non-virtual counterpart. Conclusion Overall, our findings suggest that AR does not have a significant affect on short-term memory with digits.

This study was conducted to explore the processes educators in higher education used to ground their design of online instruction using scientific-based research and theory. Literature reviewed suggested reasons educators fail to ground the design of instruction were a lack of formal training in instructional methods, skills, support, and research understanding. The rationale for the study was to (a) increase understanding of how educators use scientific research and theory as a basis in decision-making during design and creation of online instruction,(b)identify best practices, and (c) add to the conversation in the instructional design field. A qualitative case study research design was utilized to interview, review course, and review documents of four participants to capture their viewpoints as to the (a) meaning of; (b) evidence; (c) step by step processes; and (d) problems associated with the processes of grounding the design of online instruction in scientific-based research and theory. Data obtained were analyzed through detailed case description, direct interpretation, cross-case analysis, pattern establishment, and naturalistic generalization. Pedagogy, instructional design, instructional technology, support, and problems emerged as key thematic issues. Findings suggested that although educators were consistent in defining meaning, followed step-by-step processes, and had evidence to support their decisions, they encountered logistical challenges of time, technology and design in the process of using scientific-based research and theory to ground the design of online instruction. The implications for practice from this research were similar to recommendations of other researchers. For this process to be smoother, regular training, peer professional interactions, and support must be present.

The United States of America has dropped behind many countries in terms of the Science and Engineering university degrees awarded since the beginning of the nineties. Multiple studies have been conducted to determine the cause of this decline in degrees awarded, and try to reverse the trend in US education. The goal of these studies was to determine the proper instructional methods that facilitate the knowledge acquisition process for the student. It has been determined that not one method works for all types of curriculum, for example methods that have been found to work effectively in curriculum that teaches procedures and physical systems often fail in curriculum that teaches abstract and conceptual content. The purpose of this study is to design an instructional method that facilitates teaching of abstract knowledge, and to demonstrate its effectiveness through empirical research. An experiment including 72 undergraduate students was conducted to determine the best method of acquiring abstract knowledge. All students were presented with the same abstract knowledge but presented in different types of organization. These organization types consisted of hierarchy referred as Bottom Up, Top Down, and Unorganized. Another factor that was also introduced is Graphing, which is a method that is believe to improve the learning process. The experiment was completed in 8 weeks and data was gathered and analyzed. The results strongly suggest that abstract knowledge acquisition is greatly improved when the knowledge is presented in a Bottom Up hierarchical fashion. On the other hand, neither Graphing nor the Top Down or Unorganized conditions affect learning in these novice students. iv This dissertation is dedicated to my parents who established my education career since the beginning of my first day of school. Their prayers and encouragements have an impact toward my life and education.

This dissertation aims to understand how attention can be used to improve sensory integration for postural control. Decades of research have been done using visual manipulations to study how healthy and clinical populations resolve multisensory (vision, vestibular, and somatosensory) mismatches to maintain postural stability. Postural control is a complex motor skill that requires accurate integration of multiple senses to maintain body alignment and orientation with respect to the environment. Age-related decline in visual, vestibular, and somatosensory acuity increases the risk for falls, and these sensory declines can be identified by assessing sensory reweighting. Sensory reweighting is the process in which the nervous redistributes the reliance, or "weight," on the sensory inputs to achieve postural stability. While the literature on sensory manipulation on postural control and fall risk has uncovered a wealth of knowledge on sensory reweighting for balance, it has neglected to identify how sensory reweighting can be improved. At the same time, motor learning literature has demonstrated the importance of focus attention during balance training to improve postural control. However, rudimentary analyses such as duration of balance and sway variability in this literature have limited deeper examination of the underlying neural mechanisms affected by focus of attention. This dissertation aims to bridge the gap between the two works of literature by implementing sensory manipulation techniques on posture using the latest technologies in virtual reality (VR) head-mount display (HMD) with motion capture and electroencephalography (EEG) recordings to study how different focuses of attention help resolve multisensory conflicts. In aim one, forty-two healthy adults participated in the study that used VR manipulation to induce a multisensory conflict. Participants were tasked to maintain upright stability on a rocker board while given different instructions on where to focus their attention. Instructions included focusing on keeping the rocker board leveled (external focus), focusing on keeping feet leveled to each other (internal focus), and focusing on staying as still as possible (control). This study revealed an immediate improvement in postural stability when instructed with external focus compared to control. This improvement was also associated with a significant decrease in visual weighting. Additionally, this aim revealed an immediate change in cortical activity within the frontal and occipital regions of the brain as identified by EEG recordings when participants are instructed to use external focus and internal focus. In aim two, twenty-eight healthy adults participated in the crossover study that demonstrated order effects when multiple instructions of attentional focus were given to the same participant for postural stability and visual reweighting. This study showed that the effects of external focus on postural stability and visual reweighting are greater when external focus is used before internal focus. However, the effects of external focus were nullified when used after using internal focus. Furthermore, the order of the instructions may have corresponded with a recency bias regarding how the participant perceived the effectiveness depending on when they received the attentional focus instruction. Guided by the findings from aims one and two, aim three recruited twenty-seven older adults to participate in a single-session balance training using repeated exposure to VR manipulation that challenged their balance on a rocker board. The older adults were randomized into one of the three groups: external focus, internal focus, and control group. The external focus group did not demonstrate an immediate reduction in visual weighting as found in aim 1. However, the external focus group did demonstrate better immediate postural stability when compared to the internal focus groups. Both external and internal focus groups revealed a significant improvement in visual weighting and postural stability across training blocks, suggesting a potential role of attentional focus on postural control adaption to repeated VR exposure. This dissertation was one of the first studies to investigate how the attentional focus impacts sensory reweighting and postural control in young and older adults using VR HMD. This project also established a VR experimental paradigm that can be used to study the focus of attention and the resolution of multisensory mismatch. With the increased use of VR for balance training and rehabilitation, this project is at the forefront of utilizing VR HMD technology to expose underlying sensory mechanisms for postural control. Results from this study can guide future rehabilitation and balance training interventions by identifying how attention should be directed during training. / Public Health