The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

PKBackground: Globally, flexible work arrangements - through the use of temporary nursing staff - are an important strategy for dealing with nursing shortages in hospitals. Objective: The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods: Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD R7, 2010 prices). Results: In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion: Hospital managers and policy-makers need to address the effective utilisation of agency nurses and quality of patient care in tandem

The HI Mass Function and Velocity Width Function of Void Galaxies in the Arecibo Legacy Fast ALFA Survey

We measure the HI mass function (HIMF) and velocity width function (WF) across environments over a range of masses $7.2<\log(M_{HI}/M_{\odot})<10.8$, and profile widths $1.3\log(km/s)<\log(W)<2.9\log(km/s)$, using a catalog of ~7,300 HI-selected galaxies from the ALFALFA Survey, located in the region of sky where ALFALFA and SDSS (Data Release 7) North overlap. We divide our galaxy sample into those that reside in large-scale voids (void galaxies) and those that live in denser regions (wall galaxies). We find the void HIMF to be well fit by a Schechter function with normalization $\Phi^*=(1.37\pm0.1)\times10^{-2} h^3Mpc^{-3}$, characteristic mass $\log(M^*/M_{\odot})+2\log h_{70}=9.86\pm0.02$, and low-mass-end slope $\alpha=-1.29\pm0.02$. Similarly, for wall galaxies, we find best-fitting parameters $\Phi^*=(1.82\pm0.03)\times10^{-2} h^3Mpc^{-3}$, $\log(M^*/M_{\odot})+2\log h_{70}=10.00\pm0.01$, and $\alpha=-1.35\pm0.01$. We conclude that void galaxies typically have slightly lower HI masses than their non-void counterparts, which is in agreement with the dark matter halo mass function shift in voids assuming a simple relationship between DM mass and HI mass. We also find that the low-mass slope of the void HIMF is similar to that of the wall HIMF suggesting that there is either no excess of low-mass galaxies in voids or there is an abundance of intermediate HI mass galaxies. We fit a modified Schechter function to the ALFALFA void WF and determine its best-fitting parameters to be $\Phi^*=0.21\pm0.1 h^3Mpc^{-3}$, $\log(W^*)=2.13\pm0.3$, $\alpha=0.52\pm0.5$ and high-width slope $\beta=1.3\pm0.4$. For wall galaxies, the WF parameters are: $\Phi^*=0.022\pm0.009 h^3Mpc^{-3}$, $\log(W^*)=2.62\pm0.5$, $\alpha=-0.64\pm0.2$ and $\beta=3.58\pm1.5$. Because of large uncertainties on the void and wall width functions, we cannot conclude whether the WF is dependent on the environment.Comment: Accepted for publication at MNRAS, 14 pages, 12 figure

The Lunar Orbiter Photographic System

Lunar orbiter photographic syste

Counting Rotational Sets for Laminations of the Unit Disk from First Principles

By studying laminations of the unit disk, we can gain insight into the structure of Julia sets of polynomials and their dynamics in the complex plane. The polynomials of a given degree, $d$, have a parameter space. The hyperbolic components of such parameter spaces are in correspondence to rotational polygons, or classes of "rotational sets", which we study in this paper. By studying the count of such rotational sets, and therefore the underlying structure behind these rotational sets and polygons, we can gain insight into the interrelationship among hyperbolic components of the parameter space of these polynomials. These rotational sets are created by uniting rotational orbits, as we define in this paper. The number of such sets for a given degree $d$, rotation number $\frac pq$, and cardinality $k$ can be determined by analyzing the potential placements of pre-images of zero on the unit circle with respect to the rotational set under the $d$-tupling map. We obtain a closed-form formula for the count. Though this count is already known based upon some sophisticated results, our count is based upon elementary geometric and combinatorial principles, and provides an intuitive explanation.Comment: 12 pages, 5 figure

Multiple Transcripts Encode Full-Length Human Cytomegalovirus IE1 and IE2 Proteins during Lytic Infection

ABSTRACT Expression of the human cytomegalovirus (HCMV) IE1 and IE2 proteins is critical for the establishment of lytic infection and reactivation from viral latency. Defining the mechanisms controlling IE1 and IE2 expression is therefore important for understanding how HCMV regulates its replicative cycle. Here we identify several novel transcripts encoding full-length IE1 and IE2 proteins during HCMV lytic replication. Two of the alternative major immediate early (MIE) transcripts initiate in the first intron, intron A, of the previously defined MIE transcript, while others extend the 5′ untranslated region. Each of the MIE transcripts associates with polyribosomes in infected cells and therefore contributes to IE1 and IE2 protein levels. Surprisingly, deletion of the core promoter region of the major immediate early promoter (MIEP) from a plasmid containing the MIE genomic locus did not completely abrogate IE1 and IE2 expression. Instead, deletion of the MIEP core promoter resulted in increased expression of alternative MIE transcripts, suggesting that the MIEP suppresses the activity of the alternative MIE promoters. While the canonical MIE mRNA was the most abundant transcript at immediate early times, the novel MIE transcripts accumulated to levels equivalent to that of the known MIE transcript later in infection. Using two HCMV recombinants, we found that sequences in intron A of the previously defined MIE transcript are required for efficient IE1 and IE2 expression and viral replication. Together, our results identify new regulatory sequences controlling IE1 and IE2 expression and suggest that multiple transcription units act in concert to regulate IE1 and IE2 expression during lytic infection. IMPORTANCE The HCMV IE1 and IE2 proteins are critical regulators of HCMV replication, both during primary infection and reactivation from viral latency. This study expands our understanding of the sequences controlling IE1 and IE2 expression by defining novel transcriptional units controlling the expression of full-length IE1 and IE2 proteins. Our results suggest that alternative promoters may allow for IE1 and IE2 expression when MIEP activity is limiting, as occurs in latently infected cells

Disabled Laborers And The Equal Employment Opportunity Commission’s (EEOCs) Nightmare

In 2012, EEOC v. Henry’s Turkey Service was one of the largest disability settlements in American history.  Henry’s Turkey Service was ordered to pay $240 million for paying mentally disabled workers with I.Q.s estimated in the 60-70 range, 41 cents per hour and housing them in unsafe housing and health conditions (Hsieh, 2013).  Over forty years, Henry’s Turkey Service relocated hundreds of mentally disabled workers from Texas to Iowa where they were subjected to horrendous living conditions with unlawful, minimal pay—about$65.00 per month, while they worked at a local turkey processing factory in West Liberty, Iowa.  The actual case shows a pattern of violations of the Fair Labor Standards Act of 1938 and Americans with Disability Act, 1990. After a raid of the bright blue, florescent colored, century old school house in Atalissa, Iowa, these employers were brought to justice.  This case study is about one of the largest EEOC settlements in the history of the United States; yet due to federal damage caps was cut to $1.6 million for all of the men and their estates. The graphic account of the inhumane treatment and degradation of the labors presented in this study is not provided for gratuitous or salacious purposes; rather, it places into context what can occur when governmental regulations and laws go unheeded, unenforced and when authorities are apprised of wrongdoing possibilities stand idly by and in this case, do nothing for 35 years.

Infrared radiometer for measuring thermophysical properties of wind tunnel models

An infrared radiometer is described which was developed to measure temperature rises of wind tunnel models undergoing transient heating over a temperature range of -17.8 C to 260 C. This radiometer interfaces directly with a system which measures the effective thermophysical property square root of rho ck. It has an output temperature fluctuation of 0.26 C at low temperatures and 0.07 C at high temperatures, and the output frequency response of the radiometer is from dc to 400 hertz

Human Cytomegalovirus Stimulates the Synthesis of Select Akt-Dependent Antiapoptotic Proteins during Viral Entry To Promote Survival of Infected Monocytes

ABSTRACT Primary peripheral blood monocytes are responsible for the hematogenous dissemination of human cytomegalovirus (HCMV) following a primary infection. To facilitate viral spread, we have previously shown HCMV to extend the short 48-h life span of monocytes. Mechanistically, HCMV upregulated two specific cellular antiapoptotic proteins, myeloid leukemia sequence 1 (Mcl-1) and heat shock protein 27 (HSP27), to block the two proteolytic cleavages necessary for the formation of fully active caspase 3 and the subsequent initiation of apoptosis. We now show that HCMV more robustly upregulated Mcl-1 than normal myeloid growth factors and that Mcl-1 was the only myeloid survival factor to rapidly induce HSP27 prior to the 48-h cell fate checkpoint. We determined that HCMV glycoproteins gB and gH signal through the cellular epidermal growth factor receptor (EGFR) and αvβ3 integrin, respectively, during viral entry in order to drive the increase of Mcl-1 and HSP27 in an Akt-dependent manner. Although Akt is known to regulate protein stability and transcription, we found that gB- and gH-initiated signaling preferentially and cooperatively stimulated the synthesis of Mcl-1 and HSP27 through mTOR-mediated translation. Overall, these data suggest that the unique signaling network generated during the viral entry process stimulates the upregulation of select antiapoptotic proteins allowing for the differentiation of short-lived monocytes into long-lived macrophages, a key step in the viral dissemination strategy. IMPORTANCE Human cytomegalovirus (HCMV) infection is endemic within the human population. Although primary infection is generally asymptomatic in immunocompetent individuals, HCMV is a significant cause of morbidity and mortality in the immunocompromised. The multiorgan inflammatory diseases associated with symptomatic HCMV infection are a direct consequence of the monocyte-mediated systemic spread of the virus. In order for peripheral blood monocytes to facilitate viral dissemination, HCMV subverts the short 48-h life span of monocytes by inducing the expression of cellular antiapoptotic proteins Mcl-1 and HSP27. Here, we demonstrate that the rapid and simultaneous upregulation of Mcl-1 and HSP27 is a distinctive feature of HCMV-induced monocyte survival. Moreover, we decipher the signaling pathways activated during viral entry needed for the robust synthesis of Mcl-1 and HSP27. Identifying the virus-specific mechanisms used to upregulate select cellular factors required for the survival of HCMV-infected monocytes is important to the development of new classes of anti-HCMV drugs