The utilization of the medical and surgical nursing care studies to measure the extent of integration of the basic aspects of rehabilitation nursing in a basic collegiate program

Thesis (M.S.)--Boston Universit

Annual Performance Reviews Of, For and By Faculty: A Qualitative Analysis of One Department's Experiences

Purpose: Although annual performance reviews and feedback are recommended for faculty development, best practices and faculty perceptions have not been documented. The authors sought to evaluate the process in one medical school department that established and has sustained an innovative review tradition for 25 years. Method: Content analysis of faculty reports and immersion/crystallization to analyze interviews. Results: Faculty reports described satisfaction and dissatisfaction; facilitators and barriers to goals; and requests for feedback, with community, collaboration and mentorship integral to all three. Interviewees emphasized practical challenges, the role of the mentor and the power of the review to establish community norms. Conclusion: Respondents generally found reviews constructive and supportive. The process informs departmental expectations and culture

Hyperstaticity and loops in frictional granular packings

The hyperstatic nature of granular packings of perfectly rigid disks is analyzed algebraically and through numerical simulation. The elementary loops of grains emerge as a fundamental element in addressing hyperstaticity. Loops consisting of an odd number of grains behave differently than those with an even number. For odd loops, the latent stresses are exterior and are characterized by the sum of frictional forces around each loop. For even loops, the latent stresses are interior and are characterized by the alternating sum of frictional forces around each loop. The statistics of these two types of loop sums are found to be Gibbsian with a "temperature" that is linear with the friction coefficient mu when mu<1.Comment: 4 pages; Powders and Grains 2009, Golden, Colorado, US

Heritage, Tourism, and Race

Heritage, Tourism, and Race views heritage and leisure tourism in the Americas through the lens of race, and is especially concerned with redressing gaps in recognizing and critically accounting for African Americans as an underrepresented community in leisure. Fostering critical public discussions about heritage, travel, tourism, leisure, and race, Jackson addresses the underrepresentation of African American leisure experiences and links Black experiences in this area to discussions of race, place, spatial imaginaries, and issues of segregation and social control explored in the fields of geography, architecture, and the law. Most importantly, the book emphasizes the importance of shifting public dialogue from a singular focus on those groups who are disadvantaged within a system of racial hierarchy, to those actors and institutions exerting power over racialized others through practices of exclusion. Heritage, Tourism, and Race will be invaluable reading for academics and students engaged in the study of museums, as well as architecture, anthropology, public history, and a range of other disciplines. It will also be of interest to museum and heritage professionals and those studying the construction and control of space and how this affects and reveals the narratives of marginalized communities

Neonatal Lupus Erythematosus: New Serologic Findings

A child with neonatal lupus was evaluated and found to possess serum anti Ro(SSA) antibodies. The cutaneous lesions and anti Ro(SSA) antibodies disappeared during the next 5 mo.The infant's mother was asymptomatic but possessed anti Ro(SSA) and anti La(SSB) antibodies

Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results.

ObjectivesTo describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage.MethodsFrom October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up. All patients had detachable coils placed to occlude the efferent shunt and retrograde gelfoam embolization to achieve complete thrombosis/obliteration of varices. Technical success, clinical success, rebleeding, and complications were evaluated at follow-up.ResultsA 100% technical success rate (defined as achieving complete occlusion of efferent shunt with complete thrombosis/obliteration of bleeding varices and/or stopping variceal bleeding) was demonstrated in all 20 patients. Clinical success rate (defined as no variceal rebleeding) was 100%. Follow-up computed tomography after CARTO demonstrated decrease in size with complete thrombosis and disappearance of the varices in all 20 patients. Thirteen out of the 20 had endoscopic confirmation of resolution of varices. Minor post-CARTO complications, including worsening of esophageal varices (not bleeding) and worsening of ascites/hydrothorax, were noted in 5 patients (25%). One patient passed away at 24 days after the CARTO due to systemic and portal venous thrombosis and multi-organ failure. Otherwise, no major complication was noted. No variceal rebleeding was noted in all 20 patients during mean follow-up of 384±154 days.ConclusionsCARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-esophageal variceal bleeding

Veiligheid in de zorg

De onderzoeksvraag Van gezondheidszorginstellingen wordt verwacht dat zij investeren in de veiligheid van de door hen geleverde zorg (Meurs 2008). Burgers – als zij onverhoopt patiënt en/of cliënt worden van een zorginstelling – moeten er op kunnen vertrouwen dat de kwaliteit van de zorg goed is en dat er veilig wordt gewerkt. Terwijl de professionals voor goede kwaliteit zorgen, zijn managers, bestuurders en toezichthouders verantwoordelijk voor de randvoorwaarden opdat goede kwaliteit ook geleverd kan worden. Tronto maakt in dit verband het onderscheid tussen zorgen dat en zorgen voor. Managers en bestuurders zijn verantwoordelijk voor het realiseren van de randvoorwaarden die professionals nodig hebben om goede kwaliteit en veiligheid te leveren (Tronto 1994). Toezichthouders zien hierop toe. Professionals zorgen voor de feitelijke kwaliteit en veiligheid van patiëntenzorg in het dagelijks handelen en hebben ook een verantwoordelijkheid om zich te verantwoorden over de wijze waarop zij kwaliteit en veiligheid waarborgen. In nationale kwaliteitsprogr

Monitoring activated clotting time for combined heparin and aprotinin application: in vivo evaluation of a new aprotinin-insensitive test using Sonoclot

Objective: Kaolin-based activated clotting time assessed by HEMOCHRON (HkACT) is a clinical standard for heparin monitoring alone and combined with aprotinin during cardiopulmonary bypass (CPB). However, aprotinin is known to prolong not only celite-based but also kaolin-based activated clotting time. Overestimation of activated clotting times implies a potential hazardous risk of subtherapeutic heparin anticoagulation. Recently, a novel ‘aprotinin-insensitive' activated clotting time test has been developed for the SONOCLOT analyzer (SaiACT). The aim of our study was to evaluate SaiACT in patients undergoing CPB in presence of heparin and aprotinin. Methods: Blood samples were taken from 44 elective cardiac surgery patients at the following measurement time points: baseline (T0); before CPB after heparinization (T1 and T2); on CPB, before administration of aprotinin (T3); 15, 30, and 60min on CPB after administration of aprotinin (T4, T5, and T6); after protamine infusion (T7). On each measurement time point, activated clotting time was assessed with HkACT and SaiACT, both in duplicate. Furthermore, the rate of factor Xa inhibition and antithrombin concentration were measured. Statistical analysis was done using Bland and Altman analysis, Pearson's correlation, and ANOVA with post hoc Bonferroni-Dunn correction. Results: Monitoring anticoagulation with SaiACT showed reliable readings. Compared to the established HkACT, SaiACT values were lower at all measurement time points. On CPB but before administration of aprotinin (T3), SaiACT values (mean±SD) were 44±118s lower compared to HkACT. However, the difference between the two measurement techniques increased significantly on CPB after aprotinin administration (T4-T6; 89±152s, P=0.032). Correlation of ACT measurements with anti-Xa activity was unchanged for SaiACT before and after aprotinin administration (r2=0.473 and 0.487, respectively; P=0.794), but was lower for HkACT after aprotinin administration (r2=0.481 and 0.361, respectively; P=0.041). On CPB after administration of aprotinin, 96% of all ACT values were classified as therapeutic by HkACT, but only 86% of all values were classified therapeutic if ACT was determined by SaiACT. Test variability was comparable for SaiACT and HkACT. Conclusions: The use of SaiACT may result in more consistent heparin management that is less affected by aprotinin and a corresponding increase in heparin administration for patients receiving aprotini