The Impact of Nursing Skill Mix on the Outcomes of Hospitalized Adult Surgical Patients

ABSTRACT THE IMPACT OF NURSING SKILL MIX ON THE OUTCOMES OF HOSPITALIZED ADULT SURGICAL PATIENTS Danielle Altares Sarik Ann Kutney-Lee Rates of harm to surgical patients remain largely unchanged despite decades of initiatives to address safety concerns, while wide variations in mortality and failure to rescue (FTR) persist between hospitals. Despite the critical role that registered nurses (RNs) play in providing care to hospitalized patients, there has been limited exploration of the relationship between nursing skill mix and surgical patient outcomes. The purpose of this study was to examine the association between nursing skill mix and adult surgical patient 30-day mortality and FTR. This retrospective, cross-sectional, secondary data analysis utilized three datasets to study surgical patient outcomes in four states (California, Florida, New Jersey, Pennsylvania): the 2006-2007 Multi-State Nursing Care and Patient Safety Survey, the 2006-2007 American Hospital Association Annual Survey, and hospital discharge abstracts for patients age 18-85 years who underwent general, orthopedic, or vascular surgical procedures in non-federal acute care hospitals in 2006-2007. A total of 1,267, 516 surgical patients, 29,391 nurses, and 665 hospitals comprised the final sample. Logistic regression models were used to assess the association of nursing skill mix, defined as the proportion of RNs to all nursing staff (RNs, licensed practical and vocational nurses (LPN/LVNs), and unlicensed assistive personnel (UAPs)) on 30-day mortality and FTR. After analysis, each 10% increase in RN skill mix was associated with a 7% decrease in the odds of 30-day mortality (P\u3c0.001) and FTR (P\u3c0.01) in the surgical patient population. Additionally, each 10% increase in the proportion of LPN/LVNs was associated with a 6% increase in the odds of both 30-day mortality (P\u3c0.05) and FTR (P\u3c0.05), while every 10% increase in UAP proportion was associated with a 6% increase in the odds of 30-day mortality (P\u3c0.01) and a 5% increase in the odds of FTR (P\u3c0.05). As healthcare reform continues to place pressure on hospital administrators to increase quality and decrease costs, maintaining a nursing skill mix with a high proportion of RNs may be one strategy to improve surgical patient mortality and FTR

Penerapan Metode: Amati Tiru Modifikasi Pada Seni Desain Poster Dalam Perspektif Hak Cipta

Karya seni yang merupakan hasil pemikiran manusia dalam perkembangannya banyak dipengaruhi dari hasil karya-karya seni terdahulu. Hasil karya seseorang dapat memberikan inspirasi bagi seorang lainnya. Sejalan dengan majunya perkembangan teknologi berbanding lurus dengan banyaknya keberadaan desainer-desainer dengan karya-karya yang luar biasa yang dengan mudah di pamerkan di media sosial. Publikasi karya pada media sosial merupakan suatu bentuk hak pribadi apabila terdapat elemen berupa profiling dalam penyebaran karya. Mudahnya publikasi dapat menimbulkan metode baru dalam membuat suatu karya, metode Amati Tiru Modifikasi (ATM) menjadi sasaran bagi setiap orang yang ingin mengikuti lomba desain secara digital karena sangat mudah mengkases karya orang lain dan didaur ulang kembali untuk diikut sertakan pada lomba baru di sosial media. Metode Amati Tiru Modifikasi atau seringkali disebut dengan Metode ATM merupakan metode yang dapat dijadikan sebagai sarana pengembangan skill seseorang khususya dalam kemampuan mendesain.Kata kunci: Karya Seni, Modifikasi, Hak Cipta, Desai

Improvements in Liquid Chromatography coupled to Mass Spectrometry methods for the determination of legislated and emerging marine toxins in the Northwest Mediterranean coast

L’objectiu d’aquesta tesi és millorar l’aplicació de mètodes de cromatografia de líquids acoblada a espectrometria de masses (LC-MS) per a l’estudi de toxines lipofíliques i emergents produïdes per microalgues en un ecosistema litoral mediterrani (Delta de l’Ebre, Catalunya, NO Mar Mediterrani). La primera contribució fou l’avaluació de diferents condicions per implementar el mètode de control de referència de toxines lipofíliques en bivalves, obtenint majors rendiments i complint amb els requeriments legals. Aquest mètode s’aplicà en l’estudi d’una floració de Dinophysis sacculus a la badia dels Alfacs, considerant diferents aproximacions per caracteritzar el risc: anàlisi de toxines en microalgues, dissoltes en aigua, i en bivalves. Els perfils toxínics de D. sacculus només presentaren àcid okadaic i pectenotoxina-2 (la toxina principal). El contingut de toxina total per cèl·lula s’incrementà cap al final de la floració, coincidint amb la màxima concentració d’àcid okadaic en musclos (fins a 3,7 vegades el màxim permès a Europa), la concentració de pectenotoxines fou menor. Els ostrons no acumularen toxines per sobre del nivell màxim permès. El mètode LC-MS permeté la detecció de les toxines emergents pinatoxina-g (primera detecció a Espanya) i espiròlid-1, les quals foren confirmades inequívocament mitjançant MS d’alta resolució, en concentracions baixes en marisc i mostrejadors passius. No es detectaren metabòlits acilats de pinatoxines i els falsos positius es descartaren amb informació ortogonal. Les toxines emergents denominades palitoxines també s’investigaren, i es descobriren dues noves palitoxines en cultius de noves soques d’Ostreopsis cf. ovata de Catalunya: l’ovatoxina-g (46-dehidroxi ovatoxina-a) i un isòmer de la palitoxina (anteriorment “palitoxina putativa”), igual que la palitoxina però hidroxilada en C-42 i entre l’extrem A y C-8, i deshidroxilada en C-17 i probablement en C-64. Els perfils toxínics contenien ovatoxines-a,-b,-c,-d i –e, amb concentracions per cèl·lula majors que les d’altres soques mediterrànies.El objetivo de esta tesis es mejorar la aplicación de métodos de cromatografía de líquidos acoplada a espectrometría de masas (LC-MS) para el estudio de toxinas lipofílicas y emergentes producidas por microalgas en un ecosistema litoral mediterráneo (Delta del Ebro, Cataluña, NO Mar Mediterráneo). La primera contribución fue la evaluación de diferentes condiciones para implementar el método de control de referencia de toxinas lipofílicas en bivalvos, obteniendo mayores rendimientos y cumpliendo con los requerimientos legales. Este método se aplicó al estudio de una floración de Dinophysis sacculus en la bahía de Alfacs, considerando diferentes aproximaciones para caracterizar el riesgo: análisis de toxinas en microalgas, disueltas en agua, y en bivalvos. Los perfiles toxínicos de D. sacculus sólo presentaron ácido okadaico y pectenotoxina-2 (la más abundante). El contenido de toxina total por célula se incrementó hacia el final de la floración, coincidiendo con la máxima concentración de ácido okadaico en mejillones (hasta 3.7 veces el máximo permitido en Europa), la concentración de pectenotoxinas fue menor. Las ostras no acumularon toxinas por encima del nivel permitido. El método LC-MS permitió la detección de pinatoxina-g (primera detección en España) y espirólido-1 (toxinas emergentes), confirmadas inequívocamente mediante MS de alta resolución, en concentraciones bajas en bivalvos y muestreadores pasivos. No se detectaron metabolitos acilados de pinatoxinas, y los falsos positivos se descartaron con información ortogonal. Las toxinas emergentes denominadas palitoxinas también se investigaron, y se descubrieron dos nuevas palitoxinas en cultivos de nuevas cepas de Ostreopsis cf. ovata de Cataluña: ovatoxina-g (46-dehidroxi ovatoxina-a) y un isómero de la paltoxina (anteriormente “palitoxina putativa”), igual que la palytoxina pero hidroxilada en C-42 y entre el extremo A y C-8, y dehidroxilada en C-17 y probablemente en C-64. Los perfiles toxínicos contenían ovatoxinas-a,-b,-c,-d y –e, con concentraciones por célula mayores que las de otras cepas mediterráneas.This thesis aims to improve the application of liquid chromatography coupled to mass spectrometry (LC-MS) methods for the study of lipophilic and emerging toxins produced by microalgae in a coastal Mediterranean environment (Ebro Delta, Catalonia, Spain, NW Mediterranean Sea). The first contribution was the evaluation of different conditions for the implementation of the official reference control method for lipophilic toxins in shellfish, in order to obtain higher sample throughput and meet legal requirements. This method was applied to study a bloom of Dinophysis sacculus in Alfacs Bay, considering different approaches to characterize risks: analysis of toxins in microalagae, dissolved in water and in shellfish. Toxin profiles of D. sacculus only included okadaic acid and pectenotoxin-2 (the most abundant). Toxin content per cell increased towards the end of the bloom, concomitant with the maximum okadaic acid concentration in mussels (up 3.7 times the maximum permitted level in Europe), pectenotoxins were accumulated at lower concentrations. Oysters did not accumulate toxins over the maximum permitted level. The optimized method allowed the detection of the emerging toxins pinnatoxin-g (first report in Spain) and spirolide-1, which were unequivocally confirmed by High Resolution MS at low concentrations in shellfish and passive samplers. Acyl ester metabolites of pinnatoxins were not detected, and false positives were discarded by orthogonal information. The emerging toxins named palytoxins were also investigated in the study area, and two new palytoxins were discovered in cultures of new strains of Ostreopsis cf. ovata from Catalonia: ovatoxin-g (46-dehydroxy ovatoxin-a) and isomeric palytoxin (formerly “putative palytoxin”), like palytoxin but hydroxylated at C-42 and in the segment from the A-side terminal to C-8, and dehydroxilated at C-17 and most likely at C-64. Toxin profiles also contained ovatoxin-a, -b, -c, -d and –e, at concentrations per cell higher than toxin quotas reported for other Mediterranean strains

Estudio de la cuantificación de la capa de fibras nerviosas mediante tomografía de coherencia óptica de dominio espectral (Cirrus OCT) y de dominio tiempo (Stratus OCT) en pacientes con drusas del nervio óptico

El objetivo del presente estudio es evaluar los hallazgos en la OCT en pacientes con DNO, estudiando el disco óptico, la CFN y el espesor macular con Cirrus y Stratus OCT. De este modo se intentarán determinar la magnitud del daño asociado, variables relacionadas y la sensibilidad diagnóstica con ambas estrategias así como su grado de correlación con la disfunción visual y perimétrica. La OCT es un test diagnóstico útil y fiable para evaluar la afectación de la CFN en pacientes con DNO. Esta afectación de la CFN se ha relacionado con la disfunción visual y perimétrica en estos pacientes. Determinados parámetros de la OCT pueden ser útiles en el diagnóstico diferencial de las DNO así como en la detección de drusas ocultas. Tanto la OCT de dominio tiempo y de dominio espectral pueden ser útiles en el diagnóstico y seguimiento de la afectación de la CFN en pacientes con DNO

Nurse employment contracts in Chinese hospitals: impact of inequitable benefit structures on nurse and patient satisfaction

PURPOSE: Ongoing economic and health system reforms in China have transformed nurse employment in Chinese hospitals. Employment of ‘bianzhi’ nurses, a type of position with state-guaranteed lifetime employment that has been customary since 1949, is decreasing while there is an increase in the contract-based nurse employment with limited job security and reduced benefits. The consequences of inequities between the two types of nurses in terms of wages and job-related benefits are unknown. This study examined current rates of contract-based nurse employment and the effects of the new nurse contract employment strategy on nurse and patient outcomes in Chinese hospitals. METHODS: This cross-sectional study used geographically representative survey data collected from 2008 to 2010 from 181 hospitals in six provinces, two municipalities, and one autonomous region in China. Logistic regression models were used to estimate the association between contract-based nurse utilization, dissatisfaction among contract-based nurses, nurse intentions to leave their positions, and patient satisfaction, controlling for nurse, patient, and hospital characteristics. PRINCIPAL RESULTS: Hospital-level utilization of contract-based nurses varies greatly from 0 to 91%, with an average of 51%. Contract-based nurses were significantly more dissatisfied with their remuneration and benefits than ‘bianzhi’ nurses who have more job security (P <0.01). Contract-based nurses who were dissatisfied with their salary and benefits were more likely to intend to leave their current positions (P <0.01). Hospitals with high levels of dissatisfaction with salary and benefits among contract-based nurses were rated lower and less likely to be recommended by patients (P < 0.05). CONCLUSIONS: Our results suggest a high utilization of contract-based nurses in Chinese hospitals, and that the inequities in benefits between contract-based nurses and ‘bianzhi’ nurses may adversely affect both nurse and patient satisfaction in hospitals. Our study provides empirical support for the ‘equal pay for equal work’ policy emphasized by the China Ministry of Health’s recent regulations, and calls for efforts in Chinese hospitals to eliminate the disparities between ‘bianzhi’ and contract-based nurses

Ostreopsis cf. ovata y Ostreopsis lenticularis (Dinophyceae: Gonyaulacales) en la Reserva Marina de Galápagos

The genus of benthic dinoflagellates Ostreopsis is of particular interest because some species negatively impact human health and coastal marine ecosystems. Ostreopsis populations from a remote area, such as the Galapagos Marine Reserve with its unique biodiversity, can provide significant data. Samples of epibionthic dinoflagellates were collected from two islands (Santa Cruz and Santa Fé) in 2017. Species of the genera Gambierdiscus, Amphidinium, Coolia and Ostreopsis were found. Ostreopsis strains were isolated to characterize their morphology, molecular biology and toxicity. Three dif­ferent morphotypes of Ostreopsis based on dorsoventral and width diameters (n=369) were distinguished. The small cell morphotype was dominant in ten samples, with abundances of up to 33405 cells g-1 fresh weight of macroalgae. A total of 16 strains were isolated from field samples with subsequent polymerase chain reaction amplifications of rDNA, 5.8S rDNA and internal transcribed space regions; 13 strains (small cell morphotype) clustered in the O. cf. ovata Atlantic/Indian/Pacific clade; and 3 strains (large cell morphotype) clustered in the Ostreopsis lenticularis genotype from the type locality. The strains proved to be non-toxic. The presence of these genera/species represents a potential threat to marine ecosystems, and it is thus important to consider benthic species in the surveillance of harmful algae blooms in the reserve.El género de los dinoflagelados bentónicos Ostreopsis es de particular interés, porque algunas especies afectan negativamente a la salud humana y a los ecosistemas marinos costeros. Las poblaciones de Ostreopsis en áreas remotas, como la Reserva Marina de Galápagos con su biodiversidad única, pueden proporcionar datos significativos a su estudio. Se recolectaron muestras de dinoflagelados epibentónicos de dos islas (Santa Cruz y Santa Fé) en 2017. Se encontraron espe­cies de los géneros Gambierdiscus, Amphidinium, Coolia y Ostreopsis. Las cepas de Ostreopsis se aislaron para caracterizar su morfología, biología molecular y toxicidad. Se distinguieron tres morfotipos diferentes de Ostreopsis basados en tamaño (n=369). El morfotipo de células pequeñas fue dominante en diez muestras, con abundancias de hasta 33405 células g–1 de peso fresco de macroalgas. Se aisló un total de 16 cepas y se secuenciaron las regiones de rDNA, 5.8S y ITS para el estudio filogenético. Trece cepas pertenecieron al morfotipo de células pequeñas agrupadas en el clado O. cf. ovata Atlántico/Índio/Pacífico y tres cepas al morfotipo de células grandes agrupadas en el clado Ostreopsis lenticularis. Ninguna de las cepas aisladas resultó ser tóxica. La presencia de estos géneros/especies representa una amenaza potencial para los ecosistemas marinos, por lo que es importante tener en cuenta las especies bentónicas en la vigilancia de la proliferación de algas nocivas en la reserva

Ostreopsis cf. ovata and Ostreopsis lenticularis (Dinophyceae: Gonyaulacales) in the Galapagos Marine Reserve

The genus of benthic dinoflagellates Ostreopsis is of particular interest because some species negatively impact human health and coastal marine ecosystems. Ostreopsis populations from a remote area, such as the Galapagos Marine Reserve with its unique biodiversity, can provide significant data. Samples of epibionthic dinoflagellates were collected from two islands (Santa Cruz and Santa Fé) in 2017. Species of the genera Gambierdiscus, Amphidinium, Coolia and Ostreopsis were found. Ostreopsis strains were isolated to characterize their morphology, molecular biology and toxicity. Three dif­ferent morphotypes of Ostreopsis based on dorsoventral and width diameters (n=369) were distinguished. The small cell morphotype was dominant in ten samples, with abundances of up to 33405 cells g-1 fresh weight of macroalgae. A total of 16 strains were isolated from field samples with subsequent polymerase chain reaction amplifications of rDNA, 5.8S rDNA and internal transcribed space regions; 13 strains (small cell morphotype) clustered in the O. cf. ovata Atlantic/Indian/Pacific clade; and 3 strains (large cell morphotype) clustered in the Ostreopsis lenticularis genotype from the type locality. The strains proved to be non-toxic. The presence of these genera/species represents a potential threat to marine ecosystems, and it is thus important to consider benthic species in the surveillance of harmful algae blooms in the reserve.El género de los dinoflagelados bentónicos Ostreopsis es de particular interés, porque algunas especies afectan negativamente a la salud humana y a los ecosistemas marinos costeros. Las poblaciones de Ostreopsis en áreas remotas, como la Reserva Marina de Galápagos con su biodiversidad única, pueden proporcionar datos significativos a su estudio. Se recolectaron muestras de dinoflagelados epibentónicos de dos islas (Santa Cruz y Santa Fé) en 2017. Se encontraron especies de los géneros Gambierdiscus, Amphidinium, Coolia y Ostreopsis. Las cepas de Ostreopsis se aislaron para caracterizar su morfología, biología molecular y toxicidad. Se distinguieron tres morfotipos diferentes de Ostreopsis basados en tamaño (n=369). El morfotipo de células pequeñas fue dominante en diez muestras, con abundancias de hasta 33405 células g–1 de peso fresco de macroalgas. Se aisló un total de 16 cepas y se secuenciaron las regiones de rDNA, 5.8S y ITS para el estudio filogenético. Trece cepas pertenecieron al morfotipo de células pequeñas agrupadas en el clado O. cf. ovata Atlántico/Índio/Pacífico y tres cepas al morfotipo de células grandes agrupadas en el clado Ostreopsis lenticularis. Ninguna de las cepas aisladas resultó ser tóxica. La presencia de estos géneros/especies representa una amenaza potencial para los ecosistemas marinos, por lo que es importante tener en cuenta las especies bentónicas en la vigilancia de la proliferación de algas nocivas en la reserva.info:eu-repo/semantics/publishedVersio

SALDI-MS and SERS Multimodal Imaging: One Nanostructured Substrate to Rule Them Both

Imaging techniques based on mass spectrometry or spectroscopy methods inform in situ about the chemical composition of biological tissues or organisms, but they are sometimes limited by their specificity, sensitivity, or spatial resolution. Multimodal imaging addresses these limitations by combining several imaging modalities; however, measuring the same sample with the same preparation using multiple imaging techniques is still uncommon due to the incompatibility between substrates, sample preparation protocols, and data formats. We present a multimodal imaging approach that employs a gold-coated nanostructured silicon substrate to couple surface-assisted laser desorption/ionization mass spectrometry (SALDI-MS) and surface-enhanced Raman spectroscopy (SERS). Our approach integrates both imaging modalities by using the same substrate, sample preparation, and data analysis software on the same sample, allowing the coregistration of both images. We transferred molecules from clean fingertips and fingertips covered with plasticine modeling clay onto our nanostructure and analyzed their chemical composition and distribution by SALDI-MS and SERS. Multimodal analysis located the traces of plasticine on fingermarks and provided chemical information on the composition of the clay. Our multimodal approach effectively combines the advantages of mass spectrometry and vibrational spectroscopy with the signal enhancing abilities of our nanostructured substrate

A Sentence Repetition Task in Spanish language: a valid tool for early language assessment

ABSTRACT Purpose Sentence Repetition Tasks (SRT) have been widely used to assess early language abilities in different languages and populations. In addition, it has been proved that performance in SRTs serve as a clinical marker to detect language difficulties. However, most of the research has been conducted in English language and with children older than 4 years of age. Despite this scarcity, [1] developed a SRT for monolingual Spanish-speaking children between 2 and 4 years of age. Initial findings showed that it is a useful tool for discriminating children with different linguistic levels. In addition, the task showed concurrent validity with a nonword repetition task. In the current study we want to explore the predictive validity of this task. Methods We conducted a longitudinal study including 20 monolingual Spanish-Speaking children who were tested twice, at 33 months of age and six months later. In addition to the SRT, participants completed a nonword repetition task [2] and the Spanish version of the Merrill-Palmer-R Developmental Scales [3]. Results showed strong and positive relationships between the different tests when first assessed. We also found strong and predictive relationships between the SRT at time 1 and SRT and the Merrill-Palmer-R at time 2. Conclusion We conclude that the SRT developed [1] is a valid tool for examining early language abilities and its changes over time