Rankings Matter: Nurse Graduates from Higher-ranked Institutions Have Higher Productivity

Background Increasing demand for baccalaureate-prepared nurses has led to rapid growth in the number of baccalaureate-granting programs, and to concerns about educational quality and potential effects on productivity of the graduating nursing workforce. We examined the association of individual productivity of a baccalaureate-prepared nurse with the ranking of the degree-granting institution. Methods For a sample of 691 nurses from general medical-surgical units at a large magnet urban hospital between 6/1/2011–12/31/2011, we conducted multivariate regression analysis of nurse productivity on the ranking of the degree-granting institution, adjusted for age, hospital tenure, gender, and unit-specific effects. Nurse productivity was coded as “top”/“average”/“bottom” based on a computation of individual nurse value-added to patient outcomes. Ranking of the baccalaureate-granting institution was derived from the US News and World Report Best Colleges Rankings’ categorization of the nurse’s institution as the “first tier” or the “second tier”, with diploma or associate degree as the reference category. Results Relative to diploma or associate degree nurses, nurses who had attended first-tier universities had three-times the odds of being in the top productivity category (OR = 3.18, p \u3c 0.001), while second-tier education had a non-significant association with productivity (OR = 1.73, p = 0.11). Being in the bottom productivity category was not associated with having a baccalaureate degree or the quality tier. Conclusions The productivity boost from a nursing baccalaureate degree depends on the quality of the educational institution. Recognizing differences in educational outcomes, initiatives to build a baccalaureate-educated nursing workforce should be accompanied by improved access to high-quality educational institutions

Surface Roughness and Hydrodynamic Boundary Conditions

We report results of investigations of a high-speed drainage of thin aqueous films squeezed between randomly nanorough surfaces. A significant decrease in hydrodynamic resistance force as compared with predicted by Taylor's equation is observed. However, this reduction in force does not represents the slippage. The measured force is exactly the same as that between equivalent smooth surfaces obeying no-slip boundary conditions, but located at the intermediate position between peaks and valleys of asperities. The shift in hydrodynamic thickness is shown to be independent on the separation and/or shear rate. Our results disagree with previous literature data reporting very large and shear-dependent boundary slip for similar systems.Comment: Revised versio

Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization

Objectives. To determine the impact of unit-level nurse staffing on quality of discharge teaching, patient perception of discharge readiness, and postdischarge readmission and emergency department (ED) visits, and cost-benefit of adjustments to unit nurse staffing. Data Sources. Patient questionnaires, electronic medical records, and administrative data for 1,892 medical–surgical patients from 16 nursing units within four acute care hospitals between January and July 2008. Design. Nested panel data with hospital and unit-level fixed effects and patient and unit-level control variables. Data Collection/Extraction. Registered nurse (RN) staffing was recorded monthly in hours-per-patient-day. Patient questionnaires were completed before discharge. Thirty-day readmission and ED use with reimbursement data were obtained by cross-hospital electronic searches. Principal Findings. Higher RN nonovertime staffing decreased odds of readmission (OR=0.56); higher RN overtime staffing increased odds of ED visit (OR=1.70). RN nonovertime staffing reduced ED visits indirectly, via a sequential path through discharge teaching quality and discharge readiness. Cost analysis projected total savings from 1 SD increase in RN nonovertime staffing and decrease in RN overtime of U.S.$11.64 million and U.S.$544,000 annually for the 16 study units. Conclusions. Postdischarge utilization costs could potentially be reduced by investment in nursing care hours to better prepare patients before hospital discharge

Integrating land financing into subnational fiscal management

Land assets have become an important source of financing capital investments by subnational governments in developing countries. Land assets, often with billions of dollars per transaction, rival and sometimes surpass subnational borrowing or fiscal transfers for capital spending. While reducing the uncertainty surrounding future debt repayment capacity, the use of land-based revenues for financing infrastructure can entail substantial fiscal risks. Land sales often involve less transparency than borrowing. Many sales are conducted off-budget, which makes it easier to divert proceeds into operating budgets. Capital revenues from sales of land assets exert a much more volatile trend and could create an incentive to appropriate auction proceeds for financing the operating budget, particularly in times of budget shortfalls during economic downturns. Furthermore, land collateral and expected future land-value appreciation for bank loans can be linked with macroeconomic risks. It is critical to develop ex ante prudential rules comparable to those governing borrowing, to reduce fiscal risks and the contingent liabilities associated with the land-based revenues for financing infrastructure.Banks&Banking Reform,Public Sector Economics,Debt Markets,Municipal Financial Management,Public&Municipal Finance

Maternal Weight after Childbirth versus Aging-Related Weight Changes

Background Pregnancy weight gain is believed to contribute to female overweight and obesity. However, most studies do not account for the changes in body weight expected to occur as women age. We examined the long-term weight trajectory of childbearing women relative to weight progression that could be expected in the absence of pregnancy. Methods From the hospital records of 32,187 women with two births in Wisconsin during 2006 to 2013, we extracted the maternal weight at pregravid, delivery, and subsequent pregravid. We predicted the corresponding aging-progressed weights using a weight-for-age equation adjusted for sociodemographic variables. Nonparametric mixed effects models estimated the average maternal weight trajectory and the corresponding aging-related progression through 5 years after birth. Results The estimated aging-related progression predicted a gradual annual weight increase of 1.94 pounds (95% confidence interval 1.90–1.98), from 152.79 pounds at pregravid to 163.76 pounds by 5 years after birth. Actual maternal weight followed a sinusoidal pattern: increasing during gestation, decreasing during the first postbirth year, converging with the aging-related progression during the second postbirth year, and then increasing at 2.89 pounds (95% confidence interval 2.23–3.55) annually and diverging upward from the aging-related progression to 168.03 pounds by 5 years after birth. Conclusion Pregnancy weight gain did not contribute to the aging-related trend, but lifestyle changes of parenthood may later exacerbate the long-term trend

Peer effects and the Freshman 15: Evidence from a natural experiment

This study investigates the importance of peer effects in explaining weight gain among freshman college students. We exploit a natural experiment that takes place on most college campuses in the US - randomized roommate assignments. While previous studies suggest that having an obese spouse, friend, or sibling increases one\u27s likelihood of becoming obese, these social interactions are clearly non-random. We collect data from female students living on campus at a private Midwestern university at the beginning and end of their first year of college. Our findings suggest that the amount of weight gained during the freshman year is strongly and negatively correlated to the roommate\u27s initial weight. Further, our analysis of behaviors suggests that female students adopt some of their roommates\u27 weight-loss behaviors which cause them to gain less weight than they otherwise would have. In particular, we find evidence that this effect may be through influences in eating, exercise, and use of weight loss supplements