The Role of Occupational Therapists in the Joint Commission’s Disease-Specific Care Certification Process: A Continuing Education Course

Disease-Specific Care Certification (DSCC) from the Joint Commission is designed to evaluate, accredit, and improve healthcare facilities and/or clinical programs seeking certification in a variety of chronic diseases or conditions across the continuum of care. The Joint Commission DSCC process is often driven by nursing specialists and administration. Unfortunately, occupational therapy (OT) practitioners are usually not involved due to a lack of knowledge about the process. Once OTs better understand the DSCC procedures, they can facilitate an efficient, effective, and evidence-based monitored certification program because of their skills in research, collaboration, leadership, and clinical practice. Engaging with a national entity, such as the Joint Commission, allows for professional growth, leadership opportunities, and corporate recognition

A qualitative study of hospital pharmacists and antibiotic governance: Negotiating interprofessional responsibilities, expertise and resource constraints Organization, structure and delivery of healthcare

© 2016 Broom et al. Background: Antibiotic treatment options for common infections are diminishing due to the proliferation of antimicrobial resistance (AMR). The impact of Antimicrobial Stewardship (AMS) programs seeking to preserve viable antibiotic drugs by governing their use in hospitals has hitherto been limited. Pharmacists have been delegated a critical role in antibiotic governance in AMS teams within hospitals but the experience of pharmacists in influencing antibiotic use has received limited attention. In this study we explore the experiences of pharmacists in antibiotic decision-making in two Australian hospitals. Methods: We conducted 19 semi-structured interviews to explore hospital-based pharmacists' perceptions and experiences of antibiotic use and governance. The analysis was conducted with NVivo10 software, utilising the framework approach. Results: Three major themes emerged in the pharmacist interviews including (1) the responsibilities of pharmacy in optimising antibiotic use and the interprofessional challenges therein; (2) the importance of antibiotic streamlining and the constraints placed on pharmacists in achieving this; and (3) the potential, but often under-utilised expertise, pharmacists bring to antibiotic optimisation. Conclusions: Pharmacists have a critical role in AMS teams but their capacity to enact change is limited by entrenched interprofessional dynamics. Identifying how hospital pharmacy's antibiotic gatekeeping is embedded in the interprofessional nature of clinical decision-making and limited by organisational environment has important implications for the implementation of hospital policies seeking to streamline antibiotic use. Resource constraints (i.e. time limitation and task prioritisation) in particular limit the capacity of pharmacists to overcome the interprofessional barriers through development of stronger collaborative relationships. The results of this study suggest that to enact change in antibiotic use in hospitals, pharmacists must be supported in their negotiations with doctors, have increased presence on hospital wards, and must be given opportunities to pass on specialist knowledge within multidisciplinary clinical teams

Addressing Ethical Issues in Studying Men’s Traumatic Stress

Like many human experiences, traumatic stress is highly gendered. Over the past several decades, a sub-stantial number of empirical studies have explored ethical issues in traumatic stress research. However, these studies have typically reported female samples or failed to account for the influence of gender in their analyses of mixed-sex samples. By extension, ethical issues that are relevant to male participants in traumatic stress research are poorly understood. After briefly exploring why the vulnerabilities of male participants are under-explored in traumatic stress research, this article highlights many ethical issues that are important to address when men participate in traumatic stress research, concluding with some sugges-tions for how these might be taken up to advance the field

What role do pharmacists play in mediating antibiotic use in hospitals? A qualitative study

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ OBJECTIVE: To understand Australian hospital pharmacists' accounts of antibiotic use, and the potential role of pharmacy in antibiotic optimisation within a tertiary hospital setting.DESIGN, SETTING AND PARTICIPANTS: Qualitative study, utilising semistructured interviews with 19 pharmacists in two hospitals in Queensland, Australia in 2014. Data was analysed using the framework approach and supported by NVivo10 qualitative data analysis software.RESULTS: The results demonstrate that (1) pharmacists' attitudes are ambivalent towards the significance of antibiotic resistance with optimising antibiotic use perceived as low priority; (2) pharmacists' current capacity to influence antibiotic decision-making is limited by the prescribing power of doctors and the perception of antibiotic use as a medical responsibility; and, (3) interprofessional and organisational barriers exist that prevent change in the hospital setting including medical hierarchies, limited contact with senior doctors and resource constraints resulting in insufficient pharmacy staffing to foster collaborative relationships and facilitate the uptake of their advice.DISCUSSION: While pharmacy is playing an increasingly important role in enhanced antibiotic governance and is a vital component of antimicrobial stewardship in Australia, role-based limitations, interprofessional dynamics and organisational/resource constraints in hospitals, if not urgently addressed, will continue to significantly limit the ability of pharmacy to influence antibiotic prescribing

The Evolutionarily Dynamics of Aposematism: a Numerical Analysis of Co-Evolution in Finite Populations

The majority of species are under predatory risk in their natural habitat and targeted by predators as part of the food web. During the evolution of ecosystems, manifold mechanisms have emerged to avoid predation. So called secondary defences, which are used after a predator has initiated prey-catching behaviour, commonly involve the expression of toxins or deterrent substances which are not observable by the predator. Hence, the possession of such secondary defence in many prey species comes with a specific signal of that defence (aposematism). This paper builds on the ideas of existing models of such signalling behaviour, using a model of co-evolution and generalisation of aversive information and introduces a new methodology of numerical analysis for finite populations. This new methodology significantly improves the accessibility of previous models. In finite populations, investigating the co-evolution of defence and signalling requires an understanding of natural selection as well as an assessment of the effects of drift as an additional force acting on stability. The new methodology is able to reproduce the predicted solutions of preceding models and finds additional solutions involving negative correlation between signal strength and the extent of secondary defence. In addition, genetic drift extends the range of stable aposematic solutions through the introduction of a new pseudo-stability and gives new insights into the diversification of aposematic displays

The application of temporal difference learning in optimal diet models

An experience-based aversive learning model of foraging behaviour in uncertain environments is presented. We use Q-learning as a model-free implementation of Temporal difference learning motivated by growing evidence for neural correlates in natural reinforcement settings. The predator has the choice of including an aposematic prey in its diet or to forage on alternative food sources. We show how the predator's foraging behaviour and energy intake depend on toxicity of the defended prey and the presence of Batesian mimics. We introduce the precondition of exploration of the action space for successful aversion formation and show how it predicts foraging behaviour in the presence of conflicting rewards which is conditionally suboptimal in a fixed environment but allows better adaptation in changing environments

The Stabilisation of Equilibria in Evolutionary Game Dynamics through Mutation: Mutation Limits in Evolutionary Games

The multi-population replicator dynamics is a dynamic approach to coevolving populations and multi-player games and is related to Cross learning. In general, not every equilibrium is a Nash equilibrium of the underlying game, and the convergence is not guaranteed. In particular, no interior equilibrium can be asymptotically stable in the multi-population replicator dynamics, e.g. resulting in cyclic orbits around a single interior Nash equilibrium. We introduce a new notion of equilibria of replicator dynamics, called mutation limits, based on a naturally arising, simple form of mutation, which is invariant under the specific choice of mutation parameters. We prove the existence of mutation limits for a large class of games, and consider a particularly interesting subclass called attracting mutation limits. Attracting mutation limits are approximated in every (mutation-)perturbed replicator dynamics, hence they offer an approximate dynamic solution to the underlying game even if the original dynamic is not convergent. Thus, mutation stabilizes the system in certain cases and makes attracting mutation limits near attainable. Hence, attracting mutation limits are relevant as a dynamic solution concept of games. We observe that they have some similarity to Q-learning in multi-agent reinforcement learning. Attracting mutation limits do not exist in all games, however, raising the question of their characterization

Prioritization of responsive maintenance tasks via machine learning-based inference

Maintenance task prioritization is essential for allocating resources. It is estimated that almost 1/3 of the maintenance cost is wasted to unnecessary activities. Task prioritization is based on risk assessment that takes into account the probability of failure and the criticality of an asset. The criticality analysis is defined by the asset owner based on several parameters, among them safety, downtime cost, productivity, whilst the probability of failure is determined based on deterioration models, regular manual inspections, or installed sensors. Currently, the latter is an extremely complicated and labour intensive procedure, when multiple and different types of assets need to be managed. This paper proposes an innovative method that exploits the advances in mobile communications, social networking, Internet of Things and machine learning to address this shortcoming. This approach brings building elements and assets online using asset tags with an online ‘asset profile’ linked to it. Users of assets are able to scan these tags using a mobile phone app to not only see the information about those assets, but also enter ‘comments’ describing issues and problems on the profiles. These comments are processed through machine learning-based inference methods to estimate the probability that a failure has occurred. This paper validates the proposed method using historical data collected from the Estate Management, of the University of CambridgeInnovate U

The effect of fight cost structure on fighting behaviour involving simultaneous decisions and variable investment levels

In the “producer–scrounger” model, a producer discovers a resource and is in turn discovered by a second individual, the scrounger, who attempts to steal it. This resource can be food or a territory, and in some situations, potentially divisible. In a previous paper we considered a producer and scrounger competing for an indivisible resource, where each individual could choose the level of energy that they would invest in the contest. The higher the investment, the higher the probability of success, but also the higher the costs incurred in the contest. In that paper decisions were sequential with the scrounger choosing their strategy before the producer. In this paper we consider a version of the game where decisions are made simultaneously. For the same cost functions as before, we analyse this case in detail, and then make comparisons between the two cases. Finally we discuss some real examples with potentially variable and asymmetric energetic investments, including intraspecific contests amongst spiders and amongst parasitoid wasps. In the case of the spiders, detailed estimates of energetic expenditure are available which demonstrate the asymmetric values assumed in our models. For the wasps the value of the resource can affect the probabilities of success of the defender and attacker, and differential energetic investment can be inferred. In general for real populations energy usage varies markedly depending upon crucial parameters extrinsic to the individual such as resource value and intrinsic ones such as age, and is thus an important factor to consider when modelling

The effect of fight cost structure on fighting behaviour

A common feature of animal populations is the stealing by animals of resources such as food from other animals. This has previously been the subject of a range of modelling approaches, one of which is the so called "producer-scrounger" model. In this model a producer finds a resource that takes some time to be consumed, and some time later a (generally) conspecific scrounger discovers the producer with its resource and potentially attempts to steal it. In this paper we consider a variant of this scenario where each individual can choose to invest an amount of energy into this contest, and the level of investment of each individual determines the probability of it winning the contest, but also the additional cost it has to bear. We analyse the model for a specific set of cost functions and maximum investment levels and show how the evolutionarily stable behaviour depends upon them. In particular we see that for high levels of maximum investment, the producer keeps the resource without a fight for concave cost functions, but for convex functions the scrounger obtains the resource (albeit at some cost)