Deposit Central School District and Deposit Teachers Association

In the Matter of Impasse Between The Deposit Central School District and The Deposit Teacher Association. PERB Case M2006-053. Sally C. Gillespie, Fact Finder

Costing hospital resources for stroke patients using phase-type models

Optimising resources in healthcare facilities is essential for departments to cope with the growing population’s requirements. An aspect of such performance modelling involves investigating length of stay, which is a key performance indicator. Stroke disease costs the United Kingdom economy seven billion pounds a year and stroke patients are known to occupy long periods of time in acute and long term beds in hospital as well as requiring support from social services. This may be viewed as an inefficient use of resources. Thrombolysis is a therapy which uses a clot-dispersing drug which is known to decrease the institutionalisation of eligible stroke patients if administered 3 h after incident but it is costly to administer to patients. In this paper we model the cost of treating stroke patients within a healthcare facility using a mixture of Coxian phase type model with multiple absorbing states. We also discuss the potential benefits of increasing the usage of thrombolysis and if these benefits balance the expense of administering the drug.peer-reviewe

Costing mixed coxian phase-type systems in a given time interval

Previously we have introduced a modelling framework to classify individuals in Mixed Coxian Phase-type Systems. We here add costs and obtain results for moments of total costs in (0, t], for an individual, and a cohort arriving at time zero. Based on data from the Belfast City Hospital Stroke Unit we use the overall modelling framework to obtain results for total cost in a given time interval to facilitate planners who have limited time horizons for budget planning.peer-reviewe

Is it beneficial to increase the provision of thrombolysis? - a discrete-event simulation model

Background: Although Thrombolysis has been licensed in the UK since 2003, it is still administered only to a small percentage of eligible patients. Aim: We consider the impact of investing the impact of thrombolysis on important acute stroke services, and the effect on quality of life. The concept is illustrated using data from the Northern Ireland Stroke Service. Design: Retrospective study. Methods: We first present results of survival analysis utilizing length of stay (LOS) for discharge destinations, based on data from the Belfast City Hospital (BCH). None of these patients actually received thrombolysis but from those who would have been eligible, we created two initial groups, the first representing a scenario where they received thrombolysis and the second comprising those who do not receive thrombolysis. On the basis of the survival analysis, we created several subgroups based on discharge destination. We then developed a discrete event simulation (DES) model, where each group is a patient pathway within the simulation. Coxian phase type distributions were used to model the group LOS. Various scenarios were explored focusing on cost-effectiveness across hospital, community and social services had thrombolysis been administered to these patients, and the possible improvement in quality of life, should the proportion of patients who are administered thrombolysis be increased. Our aim in simulating various scenarios for this historical group of patients is to assess what the cost-effectiveness of thrombolysis would have been under different scenarios; from this we can infer the likely cost-effectiveness of future policies. Results: The cost of thrombolysis is offset by reduction in hospital, community rehabilitation and institutional care costs, with a corresponding improvement in quality of life. Conclusion: Our model suggests that provision of thrombolysis would produce moderate overall improvement to the service assuming current levels of funding.peer-reviewe

Psychometric validation of the Perceived Perioperative Competence Scale-Revised Short Form

Aim: To develop a parsimonious, shortened version of the Perceived Perioperative Competence Scale-Revised for perioperative nurses to complete as part of their specialty training while retaining good psychometric properties. Design: A longitudinal online survey was adopted. Methods: A national sample of perioperative nurses from Australia completed an online survey at two different time points 6 months apart between February and October 2021. Confirmatory factor analysis was conducted for item reduction and construct validity, while criterion, convergent validity and internal consistency were examined. Results: Usable data for psychometric assessment were obtained from 485 operating room nurses at time 1 and 164 nurses at time 2. The original 40-item revised scale was reduced to an 18-item measure, maintaining its six domains. Cronbach's alpha for the 18-item scale was .92 at time 1 and .90 at time 2. Scale validation demonstrated moderate to weak positive relationships in perceived competence scores relative to general self-efficacy, years of operating room experience, postgraduate education and recency of training. Conclusions: Results suggest the 18-item Perceived Perioperative Competence Scale-Revised Short Form has initial robust psychometric properties and may be implemented in clinical settings as part of perioperative transition-to-practice, orientation programs and yearly professional development reviews. Implications for the Profession: This short-form scale can help prepare perioperative nurses to demonstrate clinical competence in a climate of increasing professional demands using a valid measure of competence required in clinical practice. Impact: Short and validated scales of perioperative competence are needed in clinical practice. Assessment of practising operating room nurses' perceived competence is essential in quality care provision, workforce planning and human resource management. This study provides an 18-item measure of the previously validated 40-item Perceived Perioperative Competence Scale-Revised. This scale can help provide an option for future testing of perioperative nurses' competence in clinical or research settings. Patient or Public Contribution: Perioperative nurses were involved in the design of the study, particularly in the assessment of validation of the tools used in the study

The mitogen-activated protein kinase kinase MEK1 stimulates a pattern of gene expression typical of the hypertrophic phenotype in rat ventricular cardiomyocytes

Adult mammalian ventricular cardiomyocytes are terminally differentiated cells that enlarge adaptively by hypertrophy. In this situation, genes normally expressed in the fetal ventricular cardiomyocyte (e.g. atrial natriuretic factor (ANF), beta-myosin heavy chain (beta-MHC), and skeletal muscle (SkM) alpha-actin) are re-expressed, and there is transient expression of immediate early genes (e.g. c-fos). Using appropriate reporter plasmids, we studied the effects of transfection of the constitutively active or dominant negative mitogen-activated protein kinase kinase MEK1 on ANF, beta-MHC, and SkM alpha-actin promoter activities in cultured ventricular cardiomyocytes. ANF expression was stimulated (maximally 75-fold) by the hypertrophic agonist phenylephrine in a dose-dependent manner (EC50, 10 microM), and this stimulation was inhibited by dominant negative MEK1. Cotransfection of dominant negative MEK1 with a dominant negative mitogen-activated protein kinase (extracellular signal-regulated protein kinase (ERK2)) increased this inhibition. Transfection with constitutively active MEK1 constructs doubled ANF promoter activity. The additional cotransfection of wild-type ERK2 stimulated ANF promoter activity by about 5-fold. Expression of beta-MHC and SkM alpha-actin was also stimulated. Promoter activity regulated by activator protein-1 or c-fos serum response element consensus sequences was also increased. We conclude that the MEK1/ERK2 cascade may play a role in regulating gene expression during hypertrophy

Is international agricultural research a global public good? : The case of rice biofortification

The status of international agricultural research as a global public good (GPG) has been widely accepted since the Green Revolution of the 1960s and 1970s. While the term was not used at the time of its creation, the Consultative Group on International Agricultural Research (CGIAR) system that evolved at that time has been described as a 'prime example of the promise, performance and perils of an international approach to providing GPGs'. Contemporary literature on international agricultural research as a GPG tends to support this view and focuses on how to operationalize the concept. This paper adopts a different starting point and questions this conceptualization of the CGIAR and its outputs. It questions the appropriateness of such a 'neutral' concept to a system born of the imperatives of Cold War geopolitics, and shaped by a history of attempts to secure its relevance in a changing world. This paper draws on a multi-sited, ethnographic study of a research effort highlighted by the CGIAR as an exemplar of GPG-oriented research. Behind the ubiquitous language of GPGs, 'partnership' and 'consensus', however, new forms of exclusion and restriction are emerging within everyday practice, reproducing North-South inequalities and undermining the ability of these programmes to respond to the needs of projected beneficiaries

New York Communities 2008: A Year of CaRDI Publications

CaRDI Reports Issue 7. Compilation of CaRDI Rural New York Minute and the Research & Policy Brief Series from 200

Sexual counselling for patients with cardiovascular disease: Protocol for a pilot study of the CHARMS sexual counselling intervention

Introduction: Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. Methods and analysis: This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. Ethics and dissemination: This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations