Validation of the Registered Nurse Assessment of Readiness for Hospital Discharge Scale

Background Statistical models for predicting readmissions have been published for high-risk patient populations but typically focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models. Objectives The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity. Methods Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency department visits within 30 days were extracted from electronic medical records. Results The RN-RHDS, both long and short forms, demonstrate acceptable reliability (Cronbach’s alphas of .90 and .73, respectively). Confirmatory factor analysis demonstrated less than adequate fit with the same four-factor structure observed in the patient version. Exploratory factor analysis identified three factors, explaining 60.2% of the variance. When nurses rate patients as less ready to go home (\u3c7 out of 10), patients are 6.4–9.3 times more likely to return to the hospital within 30 days, in adjusted models. Discussion The RN-RHDS, long and short forms, can be used to identify medical-surgical patients at risk for potential unplanned return to hospital within 30 days, allowing nurses to use their clinical judgment to implement interventions prior to discharge. Use of the RN-RHDS could enhance current readmission risk prediction models

Disease monitoring and biosecurity

Understanding and detecting diseases of amphibians has become vitally important in conservation and ecological studies in the twenty-fi rst century. Disease is defi ned as the deviance from normal conditions in an organism. The etiologies (causes) of disease include infectious, toxic, traumatic, metabolic, and neoplastic agents. Thus, monitoring disease in nature can be complex. For amphibians, infectious, parasitic, and toxic etiologies have gained the most notoriety. Amphibian diseases have been linked to declining amphibian populations, are a constant threat to endangered species, and are frequently a hazard in captive breeding programs, translocations, and repatriations. For example, a group of viruses belonging to the genus Ranavirus and the fungus Batrachochytrium dendrobatidis are amphibian pathogens that are globally distributed and responsible for catastrophic population die-offs, with B. dendrobatidis causing known species extinctions (Daszak et al. 1999; Lips et al. 2006; Skerratt et al. 2007). Some infectious diseases of amphibians share similar pathological changes; thus, their detection, recognition, and correct diagnosis can be a challenge even by trained veterinary pathologists or experienced herpetologists. This chapter will introduce readers to the most common amphibian diseases with an emphasis on those that are potentially or frequently lethal, and the techniques involved in disease monitoring. It will also outline methods of biosecurity to reduce the transmission of disease agents by humans. We start by covering infectious, parasitic, and toxic diseases. Next, surveillance methods are discussed, including methods for sample collection and techniques used in disease diagnosis. Finally, biosecurity issues for preventing disease transmission will be covered, and we provide protocols for disinfecting fi eld equipment and footwear

Ensuring Treatment Fidelity in a Multi-site Behavioral Intervention Study: Implementing NIH Behavior Change Consortium Recommendations in the SMART Trial

The Stories and Music for Adolescent/Young Adult Resilience during Transplant (SMART) study (R01NR008583; U10CA098543; U10CA095861) is an ongoing multi-site Children’s Oncology Group randomized clinical trial testing the efficacy of a therapeutic music video intervention for adolescents/young adults (11–24 years of age) with cancer undergoing stem cell transplant. Treatment fidelity strategies from our trial are consistent with the NIH Behavior Change Consortium Treatment Fidelity Workgroup (BCC) recommendations and provide a successful working model for treatment fidelity implementation in a large, multi-site behavioral intervention study. In this paper we summarize 20 specific treatment fidelity strategies used in the SMART trial and how these strategies correspond with NIH BCC recommendations in 5 specific areas: 1) study design, 2) training providers, 3) delivery of treatment, 4) receipt of treatment, and 5) enactment of treatment skills. Increased use and reporting of treatment fidelity procedures is essential in advancing the reliability and validity of behavioral intervention research. The SMART trial provides a strong model for the application of fidelity strategies to improve scientific findings and addresses the absence of published literature illustrating the application of BCC recommendations in behavioral intervention studies

A Comparison of the Use of Binary Decision Trees and Neural Networks in Top Quark Detection

The use of neural networks for signal vs.~background discrimination in high-energy physics experiment has been investigated and has compared favorably with the efficiency of traditional kinematic cuts. Recent work in top quark identification produced a neural network that, for a given top quark mass, yielded a higher signal to background ratio in Monte Carlo simulation than a corresponding set of conventional cuts. In this article we discuss another pattern-recognition algorithm, the binary decision tree. We have applied a binary decision tree to top quark identification at the Tevatron and found it to be comparable in performance to the neural network. Furthermore, reservations about the "black box" nature of neural network discriminators do not apply to binary decision trees; a binary decision tree may be reduced to a set of kinematic cuts subject to conventional error analysis.Comment: 14pp. Plain TeX + mtexsis.tex (latter available through 'get mtexsis.tex'.) Two postscript files avail. by emai

Forgiveness takes place on an attitudinal continuum from hostility to friendliness: Toward a closer union of forgiveness theory and measurement.

Researchers commonly conceptualize forgiveness as a rich complex of psychological changes involving attitudes, emotions, and behaviors. Psychometric work with the measures developed to capture this conceptual richness, however, often points to a simpler picture of the psychological dimensions in which forgiveness takes place. In an effort to better unite forgiveness theory and measurement, we evaluate several psychometric models for common measures of forgiveness. In doing so, we study people from the United States and Japan to understand forgiveness in both nonclose and close relationships. In addition, we assess the predictive utility of these models for several behavioral outcomes that traditionally have been linked to forgiveness motives. Finally, we use the methods of item response theory, which place person abilities and item responses on the same metric and, thus, help us draw psychological inferences from the ordering of item difficulties. Our results highlight models based on correlated factors models and bifactor (S-1) models. The bifactor (S-1) model evinced particular utility: Its general factor consistently predicts variation in relevant criterion measures, including 4 different experimental economic games (when played with a transgressor), and also suffuses a second self-report measure of forgiveness. Moreover, the general factor of the bifactor (S-1) model identifies a single psychological dimension that runs from hostility to friendliness while also pointing to other sources of variance that may be conceived of as method factors. Taken together, these results suggest that forgiveness can be usefully conceptualized as prosocial change along a single attitudinal continuum that ranges from hostility to friendliness. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice

Objectives: In 2007, 31.7% of Georgia adolescents in grades 9-12 were overweight or obese. Understanding the impact of policies and interventions on obesity prevalence among young people can help determine statewide public health and policy strategies. This article describes a systems model, originally launched in 2008 and updated in 2014, that simulates the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034

Article Two Warranties in Commercial Transactions: An Update

In 1978 the Cornell Law Review published a Special Project devoted to Article Two commercial warranties. Nine years have since elapsed, and we have decided to update and reassess this important area of the law. We have discovered that although judicial treatment of many aspects of Article Two warranty law has remained stable, in some instances the courts\u27 treatment has progressed and in other instances it has become unclear. This Special Project is our attempt to assemble these changes, interpret the progress, and suggest new lines of analysis to clarify areas of conflict

Sex and Death on the Western Emigrant Trail: The Biology of Three American Tragedies

This book offers a different look at how to think about the starvation and death that hounded emigrants attempting to get to California and Oregon in the early years of nineteenth-century US expansion. Specifically, the Donner party and two lesser-known Mormon handcart groups are scrutinized for what the patterns of age at death by sex can reveal. In the subtitle The Biology of Three American Tragedies, “biology” here means solely demographic data on sex and age at death. These are really the only biological variables examined, so the title Sex and Death on the Western Emigrant Trail is more accurate as to the subject matter; the subtitle promises more of a biological account than is actually delivered

Challenges and Potential Solutions to Develop and Fund NASA Flagship Missions

Large, strategic "Flagship" missions have unique characteristics that lead to challenging developmental difficulties for the National Aeronautics and Space Administration (NASA). Missions such as the Hubble Space Telescope (HST), James Webb Space Telescope (JWST), and the Mars Science Laboratory (MSL) had technical and programmatic challenges that led to significant schedule delays and subsequent cost growth. Although NASA has instituted policies that have reduced cost growth for more "typical" NASA science missions, NASA Flagship missions remain a distinct challenge due to their requirement to provide unprecedented science or tackle bold exploration goals, typically while concurrently developing new technologies. The unique challenges presented by Flagship missions make it extremely difficult to fully predict cost and schedule given that the technical and programmatic advances needed to meet performance requirements are unprecedented. This paper addresses why Flagship missions are unique and proposes a new programmatic approach to develop and fund Flagship missions