Nurse staffing, medical staffing and mortality in intensive care: an observational study

Objectives: To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact of the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Background: Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Data: Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs Design: A cross-sectional, retrospective, risk adjusted observational study. Methods: Multivariable, multilevel logistic regression. Outcome Measures: ICU and in-hospital mortality. Results: After controlling for patient characteristics and workload we found that higher numbers of nurses per bed and higher numbers of consultants were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death whereas the effect of medical staffing was across the range of patient acuity. No relationship between patient outcomes and the number of support staff was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8 hours made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on hospital mortality which gives the study additional credibility. Conclusion: This study supports claims that the availability of medical and nursing staff is associated with the survival of critically ill patients and suggests that future studies should focus on the resources of the health care team. The results emphasise the urgent need for a prospective study of staffing levels and the organisation of care in ICUs

Mitigating Milk-Associated Bacteria through Inducing Zinc Ions Antibiofilm Activity

Dairy products are a sector heavily impacted by food loss, often due to bacterial contaminations. A major source of contamination is associated with the formation of biofilms by bacterial species adopted to proliferate in milk production environment and onto the surfaces of milk processing equipment. Bacterial cells within the biofilm are characterized by increased resistance to unfavorable environmental conditions and antimicrobial agents. Members of the Bacillus genus are the most commonly found spoilage microorganisms in the dairy environment. It appears that physiological behavior of these species is somehow depended on the availability of bivalent cations in the environment. One of the important cations that may affect the bacterial physiology as well as survivability are Zn2+ ions. Thus, the aim of this study was to examine the antimicrobial effect of Zn2+ ions, intending to elucidate the potential of a zinc-based antibacterial treatment suitable for the dairy industry. The antimicrobial effect of different doses of ZnCl2 was assessed microscopically. In addition, expression of biofilm related genes was evaluated using RT-PCR. Analysis of survival rates following heat treatment was conducted in order to exemplify a possible applicative use of Zn2+ ions. Addition of zinc efficiently inhibited biofilm formation by B. subtilis and further disrupted the biofilm bundles. Expression of matrix related genes was found to be notably downregulated. Microscopic evaluation showed that cell elongation was withheld when cells were grown in the presence of zinc. Finally, B. cereus and B. subtilis cells were more susceptible to heat treatment after being exposed to Zn2+ ions. It is believed that an anti-biofilm activity, expressed in downregulation of genes involved in construction of the extracellular matrix, would account for the higher sensitivity of bacteria during heat pasteurization. Consequently, we suggest that Zn2+ ions can be of used as an effective antimicrobial treatment in various applications in the dairy industry, targeting both biofilms and vegetative bacterial cells

Ensuring rigor in qualitative data analysis:a design research approach to coding combining NVivo with traditional material methods

Deep and insightful interactions with the data are a prerequisite for qualitative data interpretation, in particular, in the generation of grounded theory. The researcher must also employ imaginative insight as they attempt to make sense of the data and generate understanding and theory. Design research is also dependent upon the researchers’ creative interpretation of the data. To support the research process, designers surround themselves with data, both as a source of empirical information and inspiration to trigger imaginative insights. Constant interaction with the data is integral to design research methodology. This article explores a design researchers approach to qualitative data analysis, in particular, the use of traditional tools such as colored pens, paper, and sticky notes with the CAQDAS software, NVivo for analysis, and the associated implications for rigor. A design researchers’ approach which is grounded in a practice which maximizes researcher data interaction in a variety of learning modalities ensures the analysis process is rigorous and productive. Reflection on the authors’ research analysis process, combined with consultation with the literature, would suggest digital analysis software packages such as NVivo do not fully scaffold the analysis process. They do, however, provide excellent data management and retrieval facilities that support analysis and write-up. This research finds that coding using traditional tools such as colored pens, paper, and sticky notes supporting data analysis combined with digital software packages such as NVivo supporting data management offer a valid and tested analysis method for grounded theory generation. Insights developed from exploring a design researchers approach may benefit researchers from other disciplines engaged in qualitative analysis

Beautiful nerds: growing a rigorous design research dialogue in the Irish context

Ireland is a country with a small and emergent design research community. Relative to other countries, the practice of design itself in Ireland is a recent development with the first formal design courses materialising in the mid-1970s. Without historical legacy and sustained coordinated support from design specific state development agencies, the progress of this nascent Irish design sector has been fragmented and unfocused. Irish Design 2015 (ID2015) a yearlong government backed initiative sought to address this lack of coherence in tandem with increasing the visibility and profile of Irish design. This article reflects on the historical context Irish design research and practice sits within and explores the early success of the ITERATIONS Design Research and Practice review as one of a series of initiatives launched as part of ID2015. It makes the case for robust dialogue and advocacy in addressing the needs of an emergent community of practic

A design research framework to inform policy in Irish higher education

The landscape of higher education in Ireland is changing. In 2011, the National Strategy for Higher Education to 2030 was launched providing a blueprint for its future development. Part of this ongoing process will see the implementation of performance funding in the sector. Performance funding directly links state institutional funding to institutional performance as indicated by performance outcomes in key predetermined areas. This may impact significantly on design research funding and inquiry in higher education. As a practice which has developed to a significant extent outside of the university; design values, methodologies and requisites fundamental to its progression do not always align well with those of traditional academia and may not be reflected within the current strategic discussions. The focus of this research article is the implementation of performance funding within the Irish higher education sector, and its potential impact on design research funding and development, with the ensuing need for designers to articulate clearly the value of design research and its methodological approac

Hindbrain boundaries as niches of neural progenitor and stem cells regulated by the extracellular matrix proteoglycan chondroitin sulphate.

Peer reviewed: TrueAcknowledgements: We thank Einat Zelinger and Daniel Waiger from the Center for Scientific Imaging, Core Facility, Faculty of Agriculture, Food and Environmental Sciences, The Hebrew University of Jerusalem, for their help with the SEM and IMARIS analyses. We thank Adi Turjeman from The Center for Genomic Technologies, The Hebrew University of Jerusalem, for assisting with the RNA-sequencing. We thank Efrat Hagai from the Life Sciences Core Facilities, Weizmann Institute of Science, for assisting with the FACS procedure.Publication status: PublishedFunder: The Hebrew University of Jerusalem; doi: http://dx.doi.org/10.13039/501100003483The interplay between neural progenitors and stem cells (NPSCs), and their extracellular matrix (ECM) is a crucial regulatory mechanism that determines their behavior. Nonetheless, how the ECM dictates the state of NPSCs remains elusive. The hindbrain is valuable to examine this relationship, as cells in the ventricular surface of hindbrain boundaries (HBs), which arise between any two neighboring rhombomeres, express the NPSC marker Sox2, while being surrounded with the membrane-bound ECM molecule chondroitin sulphate proteoglycan (CSPG), in chick and mouse embryos. CSPG expression was used to isolate HB Sox2+ cells for RNA-sequencing, revealing their distinguished molecular properties as typical NPSCs, which express known and newly identified genes relating to stem cells, cancer, the matrisome and cell cycle. In contrast, the CSPG- non-HB cells, displayed clear neural-differentiation transcriptome. To address whether CSPG is significant for hindbrain development, its expression was manipulated in vivo and in vitro. CSPG manipulations shifted the stem versus differentiation state of HB cells, evident by their behavior and altered gene expression. These results provide further understanding of the uniqueness of hindbrain boundaries as repetitive pools of NPSCs in-between the rapidly growing rhombomeres, which rely on their microenvironment to maintain their undifferentiated state during development

A design research framework to inform policy in Irish higher education

   The landscape of higher education in Ireland is changing. In 2011, the National Strategy for Higher Education to 2030 was launched providing a blueprint for its future development. Part of this ongoing process will see the implementation of performance funding in the sector. Performance funding directly links state institutional funding to institutional performance as indicated by performance outcomes in key predetermined areas. This may impact significantly on design research funding and inquiry in higher education. As a practice which has developed to a significant extent outside of the university; design values, methodologies and requisites fundamental to its progression do not always align well with those of traditional academia and may not be reflected within the current strategic discussions. The focus of this research article is the implementation of performance funding within the Irish higher education sector, and its potential impact on design research funding and development, with the ensuing need for designers to articulate clearly the value of design research and its methodological approachITERATIONSpeer-reviewe