Exploring the stability of communication network metrics in a dynamic nursing context

Network stability is of increasing interest to researchers as they try to understand the dynamic processes by which social networks form and evolve. Because hospital patient care units (PCUs) need flexibility to adapt to environmental changes (Vardaman et al., 2012), their networks are unlikely to be uniformly stable and will evolve over time. This study aimed to identify a metric (or set of metrics) sufficiently stable to apply to PCU staff information sharing and advice seeking communication networks over time. Using Coefficient of Variation, we assessed both Across Time Stability (ATS) and Global Stability over four data collection times (Baseline and 1, 4, and 7 months later). When metrics were stable using both methods, we considered them "super stable." Nine metrics met that criterion (Node Set Size, Average Distance, Clustering Coefficient, Density, Weighted Density, Diffusion, Total Degree Centrality, Betweenness Centrality, and Eigenvector Centrality). Unstable metrics included Hierarchy, Fragmentation, Isolate Count, and Clique Count. We also examined the effect of staff members' confidence in the information obtained from other staff members. When confidence was high, the "super stable" metrics remained "super stable," but when low, none of the "super stable" metrics persisted as "super stable." Our results suggest that nursing units represent what Barker (1968) termed dynamic behavior settings in which, as is typical, multiple nursing staff must constantly adjust to various circumstances, primarily through communication (e.g., discussing patient care or requesting advice on providing patient care), to preserve the functional integrity (i.e., ability to meet patient care goals) of the units, thus producing the observed stability over time of nine network metrics. The observed metric stability provides support for using network analysis to study communication patterns in dynamic behavior settings such as PCUs.National Institute of General Medical Sciences of the National Institutes of HealthOpen access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu

Background: India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world\u2019s largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women\u2019s access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women\u2019s use of maternal health services in Gujarat and Tamil Nadu. Methods: Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Results: Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women\u2019s education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands\u2019 education predicted institutional delivery in Gujarat. Conclusions: Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood

Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu

India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world’s largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women’s access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women’s use of maternal health services in Gujarat and Tamil Nadu. Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women’s education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands’ education predicted institutional delivery in Gujarat. Overall, assistance from health financing schemes, good road access to health facilities, and socio-demographic and obstetric factors were associated with differential use of maternity health services by poor, rural women in the two states. Policymakers and practitioners should promote financing schemes to increase access, including consideration of incentives for antenatal care, and address health system and social factors in designing state-level interventions to promote safe motherhood.https://doi.org/10.1186/s41043-015-0025-

TigerPlace: An Innovative Educational and Research Environment

This item also falls under AAAI copyright. For more information, please visit http://www.aaai.org/ojs/index.php/aimagazine/indexA one of a kind project based on the concept of aging in place is in progress at the University of Missouri (MU). This project required legislation in 1999 and 2001 to be fully realized. A specialized home health agency was developed by the MU Sinclair School of Nursing specifically to help older adults age in place. In 2004, TigerPlace, a specially designed independent living environment, was built by Americare Corporation of Sikeston, Missouri, a leading long-term care company. TigerPlace was developed as a true partnership between the University of Missouri and Americare Corporation. This partnership allows for unique student and research projects.This research was supported by the U.S. Administration on Aging grant #90AM3013 and National Science Foundation ITR grants IIS-0428420 and IIS-0703692

TigerPlace, a State-Academic-Private Project to Revolutionize Traditional Long Term Care

This is a preprint of an article whose final and definitive form has been published in the Journal of Housing for the Elderly 2008, copyright Taylor & Francis. Journal of Housing for the Elderly is available online at: http://www.informaworld.com/openurl?genre=article&issn=0276-3893&volume=22&issue=1&spage=66 DOI:10.1080/02763890802097045The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.The authors wish to acknowledge the organizations and staff who made the AIP project possible: Americare of Sikeston, MO; TigerPlace staff; Sinclair Home Care staff; MU Sinclair School of Nursing faculty and deans; MU administration; Missouri Department of Health and Senior Services staff; Missouri state legislature (in particular, Tim Harlan of Columbia, MO); and all the friends and families who have supported those who implemented this pioneering effort

Diversity Outbred Mice at 21: Maintaining Allelic Variation in the Face of Selection

Multi-parent populations (MPPs) capture and maintain the genetic diversity from multiple inbred founder strains to provide a resource for high-resolution genetic mapping through the accumulation of recombination events over many generations. Breeding designs that maintain a large effective population size with randomized assignment of breeders at each generation can minimize the impact of selection, inbreeding, and genetic drift on allele frequencies. Small deviations from expected allele frequencies will have little effect on the power and precision of genetic analysis, but a major distortion could result in reduced power and loss of important functional alleles. We detected strong transmission ratio distortion in the Diversity Outbred (DO) mouse population on chromosome 2, caused by meiotic drive favoring transmission of the WSB/EiJ allele at the R2d2 locus. The distorted region harbors thousands of polymorphisms derived from the seven non-WSB founder strains and many of these would be lost if the sweep was allowed to continue. To ensure the utility of the DO population to study genetic variation on chromosome 2, we performed an artificial selection against WSB/EiJ alleles at the R2d2 locus. Here, we report that we have purged the WSB/EiJ allele from the drive locus while preserving WSB/EiJ alleles in the flanking regions. We observed minimal disruption to allele frequencies across the rest of the autosomal genome. However, there was a shift in haplotype frequencies of the mitochondrial genome and an increase in the rate of an unusual sex chromosome aneuploidy. The DO population has been restored to genome-wide utility for genetic analysis, but our experience underscores that vigilant monitoring of similar genetic resource populations is needed to ensure their long-term utility