The Role of Nurses in Hospital Quality Improvement

Presents findings from interviews with hospital executives on the role nurses play in efforts to improve the quality of hospital care, factors affecting their involvement, and the challenges they face. Describes common quality improvement programs

Massachusetts Health Reform: High Costs and Expanding Expectations May Weaken Employer Support

Examines how, as a result of the state's health reform, improved access to the individual insurance market and increased employer responsibility may reduce employers' motivation and ability to provide coverage. Considers implications

Congenital diaphragmatic hernia in the preterm infant.

BACKGROUND: Congenital diaphragmatic hernia (CDH) remains a significant cause of death in newborns. With advances in neonatal critical care and ventilation strategies, survival in the term infant now exceeds 80% in some centers. Although prematurity is a significant risk factor for morbidity and mortality in most neonatal diseases, its associated risk with infants with CDH has been described poorly. We sought to determine the impact of prematurity on survival using data from the Congenital Diaphragmatic Hernia Registry (CDHR). METHODS: Prospectively collected data from live-born infants with CDH were analyzed from the CDHR from January 1995 to July 2009. Preterm infants were defined as \u3c37 weeks estimated gestational age at birth. Univariate and multivariate logistic regression analysis were\u3eperformed. RESULTS: During the study period, 5,069 infants with CDH were entered in the registry. Of the 5,022 infants with gestational age data, there were 3,895 term infants (77.6%) and 1,127 preterm infants (22.4%). Overall survival was 68.7%. A higher percentage of term infants were treated with extracorporeal membrane oxygenation (ECMO) (33% term vs 25.6% preterm). Preterm infants had a greater percentage of chromosomal abnormalities (4% term vs 8.1% preterm) and major cardiac anomalies (6.1% term vs 11.8% preterm). Also, a significantly higher percentage of term infants had repair of the hernia (86.3% term vs 69.4% preterm). Survival for infants that underwent repair was high in both groups (84.6% term vs 77.2% preterm). Survival decreased with decreasing gestational age (73.1% term vs 53.5% preterm). The odds ratio (OR) for death among preterm infants adjusted for patch repair, ECMO, chromosomal abnormalities, and major cardiac anomalies was OR 1.68 (95% confidence interval [CI], 1.34-2.11). CONCLUSION: Although outcomes for preterm infants are clearly worse than in the term infant, more than 50% of preterm infants still survived. Preterm infants with CDH remain a high-risk group. Although ECMO may be of limited value in the extremely premature infant with CDH, most preterm infants that live to undergo repair will survive. Prematurity should not be an independent factor in the treatment strategies of infants with CDH

Up the leash: Exploring canine handlers’ perceptions of volunteering in canine-assisted interventions

To date, research on university and college based canine-assisted interventions for post-secondary students have focused on identifying the effects of spending time with therapy dogs on the well-being of participants and, to a lesser extent, exploring the effects of canine-assisted interventions on therapy dogs as a means of safeguarding canine welfare. Little empirical attention has focused on understanding the experience of volunteer canine handlers – agents at the heart of the success of canine-assisted interventions. The aim of this exploratory research was to first capture the voice of these key stakeholders to better understand their experience as canine handler volunteers and second to provide preliminary insights into their well-being. Sixty volunteer handlers with varying volunteer experience with a canine therapy program at a mid-size Canadian university responded to a series of open-ended prompts related to their volunteer work and completed a battery of well-being measures. Qualitative findings revealed that most participants identified social benefits to volunteering for themselves (64%) and for their dog (55%). The perceived impact on students (33%) and the ability to help university students (36%) were the most rewarding aspects of volunteering. Though enticed to volunteer by qualities of the CAI program (36%), participant motivations to continue volunteering were predominantly associated with personal benefits of volunteering (44%). Most handlers reported no challenges associated with volunteering (73%) and described their dog as happy after sessions (71%). Participants commonly described good therapy dogs as relaxed, calm, and respectful (66%) and strong handlers as having good awareness of their dog (48%). Quantitative findings revealed volunteer handlers reported elevated levels of positive affect (p = < 0.001, d = 1.19), greater satisfaction with life (p = < 0.001, d = 0.85) and lower levels of avoidant attachment to their therapy dog (p = < 0.001, d = -1.16) when compared to normative samples. Implications for the governing of university and college based programs and handler well-being are discussed

Open Educational Resource Textbook Impact on Students in an Introductory Nutrition Course

Objective To determine if student outcomes, usage, perceptions, and engagement differ between introductory nutrition courses that used an open educational resource (OER) textbook compared with a traditional textbook. Design Cross-sectional. Setting College introductory nutrition course. Participants Students enrolled in introductory nutrition courses that used a traditional textbook or an OER textbook. Intervention Implementation of an OER textbook in all introductory nutrition courses during 1 semester. Main Outcome Measure(s) Usage, perceptions, and engagement with the textbook were evaluated by an online survey. Student outcome data (eg, grades) were collected from the learning management system at the end of the semester. Analysis Differences in student outcomes, usage, perceptions, and engagement were determined by t tests. Open-ended responses on textbook likes and dislikes were evaluated by thematic analysis. Results The number of students who completed the introductory nutrition course with a traditional textbook (n = 346) was higher than those who completed the course with an OER textbook (n = 311). There was no difference in student outcomes between textbooks. P values for student usage ranged from <.001 to .001, <.001 for engagement, and <.001 to .001 for perception with the OER textbook, with significantly better P values for outcomes than those with the traditional textbook. The $0 cost and place-based nature were noted as positive attributes of the OER textbook, whereas students appreciated the format and visual appeal of the traditional textbook. Conclusions and Implications Academic performance in introductory nutrition was not affected by an OER textbook. An OER textbook for introductory nutrition may be an appropriate solution for institutions seeking to reduce student costs

Both helix topology and counterion distribution contribute to the more effective charge screening in dsRNA compared with dsDNA

The recent discovery of the RNA interference mechanism emphasizes the biological importance of short, isolated, double-stranded (ds) RNA helices and calls for a complete understanding of the biophysical properties of dsRNA. However, most previous studies of the electrostatics of nucleic acid duplexes have focused on DNA. Here, we present a comparative investigation of electrostatic effects in RNA and DNA. Using resonant (anomalous) and non-resonant small-angle X-ray scattering, we characterized the charge screening efficiency and counterion distribution around short (25 bp) dsDNA and RNA molecules of comparable sequence. Consistent with theoretical predictions, we find counterion mediated screening to be more efficient for dsRNA than dsDNA. Furthermore, the topology of the RNA A-form helix alters the spatial distribution of counterions relative to B-form DNA. The experimental results reported here agree well with ion-size-corrected non-linear Poisson–Boltzmann calculations. We propose that differences in electrostatic properties aid in selective recognition of different types of short nucleic acid helices by target binding partners

Chromosome 7 and 19 Trisomy in Cultured Human Neural Progenitor Cells

BACKGROUND:Stem cell expansion and differentiation is the foundation of emerging cell therapy technologies. The potential applications of human neural progenitor cells (hNPCs) are wide ranging, but a normal cytogenetic profile is important to avoid the risk of tumor formation in clinical trials. FDA approved clinical trials are being planned and conducted for hNPC transplantation into the brain or spinal cord for various neurodegenerative disorders. Although human embryonic stem cells (hESCs) are known to show recurrent chromosomal abnormalities involving 12 and 17, no studies have revealed chromosomal abnormalities in cultured hNPCs. Therefore, we investigated frequently occurring chromosomal abnormalities in 21 independent fetal-derived hNPC lines and the possible mechanisms triggering such aberrations. METHODS AND FINDINGS:While most hNPC lines were karyotypically normal, G-band karyotyping and fluorescent in situ hybridization (FISH) analyses revealed the emergence of trisomy 7 (hNPC(+7)) and trisomy 19 (hNPC(+19)), in 24% and 5% of the lines, respectively. Once detected, subsequent passaging revealed emerging dominance of trisomy hNPCs. DNA microarray and immunoblotting analyses demonstrate epidermal growth factor receptor (EGFR) overexpression in hNPC(+7) and hNPC(+19) cells. We observed greater levels of telomerase (hTERT), increased proliferation (Ki67), survival (TUNEL), and neurogenesis (beta(III)-tubulin) in hNPC(+7) and hNPC(+19), using respective immunocytochemical markers. However, the trisomy lines underwent replicative senescence after 50-60 population doublings and never showed neoplastic changes. Although hNPC(+7) and hNPC(+19) survived better after xenotransplantation into the rat striatum, they did not form malignant tumors. Finally, EGF deprivation triggered a selection of trisomy 7 cells in a diploid hNPC line. CONCLUSIONS:We report that hNPCs are susceptible to accumulation of chromosome 7 and 19 trisomy in long-term cell culture. These results suggest that micro-environmental cues are powerful factors in the selection of specific hNPC aneuploidies, with trisomy of chromosome 7 being the most common. Given that a number of stem cell based clinical trials are being conducted or planned in USA and a recent report in PLoS Medicine showing the dangers of grafting an inordinate number of cells, these data substantiate the need for careful cytogenetic evaluation of hNPCs (fetal or hESC-derived) before their use in clinical or basic science applications

How Capitalism Endogenously Creates Rising Income Inequality and Economic Crisis: The Macro Political Economy Model of Early Industrial Relations

A major economic issue today is the causes and consequences of wage stagnation and rising income inequality. This paper uncovers, describes, and formalizes the macro political economy model developed by pre–New Deal institutional/industrial relations economists to explain these issues. The model is formalized in a three‐part diagram and used to explain the role of inequality and wage stagnation in causing the Great Depression and World Financial Crisis and the appropriate policy responses.Griffith Business School, Dept of Employment Relations and Human ResourcesNo Full Tex

Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?

<p>Abstract</p> <p>Background</p> <p>Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.</p> <p>This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups.</p> <p>Methods</p> <p>A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions.</p> <p>Results</p> <p>The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening.</p> <p>Conclusions</p> <p>Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.</p

Energy source, protein metabolism, and hunter-gatherer subsistence strategies

During late winter and spring, hunter-gatherers in temperate, subarctic, and arctic environments often relied on diets that provided marginal or inadequate caloric intakes. During such periods, particularly when stored food supplies dwindled or were used up entirely, lean meat became the principal source of energy. Nutritional problems associated with high-protein, low-energy diets are discussed. These problems include elevated metabolic rates, with correspondingly higher caloric requirements, and deficiencies in essential fatty acids. The relative benefits of adding fat or carbohydrate to a diet of lean meat are evaluated in light of the protein-sparing capacities of these two nutrients. Experimental data indicate that although both enhance high-protein, low-energy diets, carbohydrate is a more effective supplement than fat. Given the nutritional inadequacies of a lean-meat diet, the paper concludes with a discussion of alternative subsistence strategies that increase the availability of carbohydrate or fat at the critical time of year.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25268/1/0000711.pd