The Effect of Moral Distress on Nursing Retention in the Acute Care Setting

This descriptive study explored the relationship between moral distress, professional stress and intent to stay in the hospital setting. The study involved 234 nursing participants and was conducted via an online survey over a 90 day period. The survey tool consisted of 51 items taken from known moral distress, professional stress and intent to stay tools. The items were divided into frequency and intensity of occurrence. Various statistical measures were utilized to conclude that moral distress and professional stress factors were significant (

Yours for the Asking. Educational Service Publication No. 27.

This publication is an annotated listing of sources of free learning materials for classroom use; with expanded sections in career education and environmental education. Part 1 is alphabetized by subject so that teachers may quickly find sources of materials pertinent to units they are teaching. In using this topical index; the reader is referred to the page or pages in part 2 which list materials related to a given topic. Part 2 classifies materials according to source; thus making it possible for the reader to note all of the items available gratis from a given organization. Grade levels are indicated for all the materials listed. An appendix is attached which lists additional sources of free materials; including general sources and specific publications. (BD

Fair Inputs and Fair Outputs: The Incompatibility of Fairness in Privacy and Accuracy

Fairness concerns about algorithmic decision-making systems have been mainly focused on the outputs (e.g., the accuracy of a classifier across individuals or groups). However, one may additionally be concerned with fairness in the inputs. In this paper, we propose and formulate two properties regarding the inputs of (features used by) a classifier. In particular, we claim that fair privacy (whether individuals are all asked to reveal the same information) and need-to-know (whether users are only asked for the minimal information required for the task at hand) are desirable properties of a decision system. We explore the interaction between these properties and fairness in the outputs (fair prediction accuracy). We show that for an optimal classifier these three properties are in general incompatible, and we explain what common properties of data make them incompatible. Finally we provide an algorithm to verify if the trade-off between the three properties exists in a given dataset, and use the algorithm to show that this trade-off is common in real data

The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel.

BACKGROUND: Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. METHODS: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. DISCUSSION: ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010)

High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs : results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique

Background Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. Methods We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. Results We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. Conclusion Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission

Archeological Significance Testing at 41BX17/271, the Granberg Site: A Multi-Component Site along the Salado Creek in Bexar County, Texas

The Center for Archaeological Research (CAR) of The University of Texas at San Antonio conducted archeological significance testing at 41BX17, the Granberg Site, from January to March 2006. The testing was conducted for the Texas Department of Transportation, Environmental Affairs Division (TxDOT-ENV). The Granberg Site sits on the eastern flood terrace of the Salado Creek south of Loop 410 in San Antonio, Bexar County, Texas. Planned road improvements including installation of a storm sewer line and a water main prompted the need to assess whether (1) cultural deposits including human remains still exist after previous testing and (2) if the deposits contribute to the site’s National Register of Historic Places eligibility. The archeological work was conducted under Texas Antiquities Permit No. 4010. Steve A. Tomka served as Principal Investigator and Jennifer Thompson served as Project Archeologist. Fieldwork included mechanical auger boring and backhoe trenching to determine the horizontal extent of the site boundaries within the median of Loop 410 eastbound. Sixteen 1-x-1-m units were excavated to determine the distribution and integrity of the cultural deposits and to locate any possible burials that may still exist at the site. Materials recovered included burned rock features, chipped stone artifacts, animal bone, snail and mussel shell and charred plant remains. The distribution of the artifacts, the geomorphic investigations, the radiocarbon assays, and temporally diagnostic artifacts indicate the presence of Middle and Late Archaic archeological materials with good stratigraphic integrity. The Granberg Site was determined to be ineligible for the National Register of Historic Places. Following the completion of eligibility testing efforts, the TxDOT directed the CAR to develop a research design linking the data recovered from the various excavations at the Granberg Site with research goals. The CAR developed the research design (Munoz et al. 2007) under Work Authorization No. 57513SA005 with Cynthia M. Munoz serving as Project Archeologist. At roughly the time of the research design implementation, the CAR was the recipient of a donation of a collection of commingled human skeletal remains recovered from the Granberg Site. These remains were recovered from 41BX17/271 in 1962 by Harvey Kohnitz, an avocational archeologist, without knowledge or permission from the Texas Highway Department. The remains were stored at the Kohnitz home until his son, Mark Kohnitz, donated them to the CAR in 2007. An osteological analysis was conducted at the CAR laboratory during February 2008 for TxDOT, under Work Authorization No. 57513SA005 Supplemental Work Authorization No. 4. The results of this analysis are reported in Appendix H of this report. The commingled remains will be curated the CAR and all required documents, including an inventory, will be submitted to the National Park Service National NAGPRA Program to fulfill all obligations pertaining to the NAGPRA laws. All artifacts collected during this project and all project-associated documentation are permanently curated at the CAR according to Texas Historical Commission guidelines

The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel.

BACKGROUND: Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. METHODS: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. DISCUSSION: ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010)

Glycogenosis is common in nonalcoholic fatty liver disease and is independently associated with ballooning, but lower steatosis and lower fibrosis

Background/aims: Glycogen synthesis and storage are normal hepatocyte functions. However, glycogenosis, defined as excess hepatocyte glycogen visible by routine H&E light microscopy, has not been well characterized in nonalcoholic fatty liver disease (NAFLD). Methods: Glycogenosis in NAFLD liver biopsies was graded as "none", "focal" (in <50% of hepatocytes), or "diffuse" (in ≥50% of hepatocytes). Clinical and pathological variables associated with glycogenosis were assessed. 2047 liver biopsies were prospectively analysed. Results: In adults and children, any glycogenosis was present in 54% of cases; diffuse glycogenosis was noted in approximately 1/3 of cases. On multiple logistic regression analysis, adults with glycogenosis tended to be older (P = .003), female (P = .04), have higher serum glucose (P = .01), and use insulin (P = .02). Adults tended to have lower steatosis scores (P = .006) and lower fibrosis stages (P = .005); however, unexpectedly, they also tended to have more hepatocyte injury including ballooning (P = .003). On multiple logistic regression analysis, paediatric patients with glycogenosis were more likely to be Hispanic (P = .03), have lower body weight (P = .002), elevated triglycerides (P = .001), and a higher fasting glucose (P = .007). Paediatric patients with glycogenosis also had less steatosis (P < .001) than those without. Conclusions: Glycogenosis is common in adult and paediatric NAFLD, and is associated with clinical features of insulin resistance. Glycogenosis is important to recognize histologically because it may be misinterpreted as ballooning, and when diffuse, confusion with glycogen storage disorders or glycogenic hepatopathy must be avoided. The newly observed dichotomous relationship between glycogenosis and increased liver cell injury but decreased steatosis and fibrosis requires further study

From Re-Emergence to Hyperendemicity: The Natural History of the Dengue Epidemic in Brazil

The spread of dengue virus is a major public health problem. Though the burden of dengue has historically been concentrated in Southeast Asian countries, Brazil has become the country that reports the largest number of cases in the world. While prior to 2007 the disease affected mostly adults, during the 2007 epidemic the number of dengue hemorrhagic fever cases more than doubled, and over 53% of cases were in children under 15 years of age. In this paper, we propose that the conditions for the shift were being set gradually since the re-introduction of dengue in 1986 and that they represent the transition from re-emergence to hyperendemicity. Using data from an age stratified seroprevalence study conducted in Recife, we estimated the force of infection (a measure of transmission intensity) between 1986–2006 and used these estimates to simulate the accumulation of immunity since the re-emergence. As the length of time that dengue has circulated increases, adults have a lower probability of remaining susceptible to primary or secondary infection and thus, cases become on average younger. If in fact the shift represents the transition from re-emergence to hyperendemicity, similar shifts are likely to be observed in the rest of Brazil, the American continent and other regions where transmission emerges