Antimicrobial Stewardship: Incentives and Barriers to Implementation in Skilled Nursing Facilities

This study was part of a quality improvement effort of a Skilled Nursing Facility (SNF) to develop and establish an antimicrobial stewardship program to comply with recently enacted California State Senate Bill 361 (SB 361), which went into effect January l, 2017 (Skilled nursing facilities, 2015). The division of the facility into two sections, one staffed largely by Licensed Vocational Nurses (L VNs) and another staffed largely by Registered Nurses (RNs) provided an study opportunity that easily differentiated the licensed nurses. This study used three methods: 1) an educational intervention to licensed nurses, 2) a post-educational intervention survey of licensed nurses, and 3), a retrospective medical chart audit of facility residents before and after the educational intervention. There was no significant difference demographic between L VNs and RNs. All agreed antimicrobial stewardship was important. While there was an increase in adherence to standardized infection criteria post-educational intervention, the most significant change was in the prescribing behavior by nurse practitioners (NPs ). In conclusion, concentrating educational efforts on NPs and allowing them to practice in all areas of a SNF, may provide the greatest impact on the success of antimicrobial stewardship programs in these facilities

A quality management based on the Quality Model life cycle

Managing quality is a hard and expensive task that involves the execution and control of processes and techniques. For a good quality management, it is important to know the current state and the objective to be achieved. It is essential to take into account with a Quality Model that specifies the purposes of managing quality. QuEF (Quality Evaluation Framework) is a framework to manage quality in MDWE (Model-driven Web Engineering). This paper suggests managing quality but pointing out the Quality Model life cycle. The purpose is to converge toward a quality continuous improvement by means of reducing effort and time.Ministerio de Ciencia e Innovación TIN2010-20057-C03-02Ministerio de Ciencia e Innovación TIN 2010-12312-EJunta de Andalucía TIC-578

Statistical Complexity and Nontrivial Collective Behavior in Electroencephalografic Signals

We calculate a measure of statistical complexity from the global dynamics of electroencephalographic (EEG) signals from healthy subjects and epileptic patients, and are able to stablish a criterion to characterize the collective behavior in both groups of individuals. It is found that the collective dynamics of EEG signals possess relative higher values of complexity for healthy subjects in comparison to that for epileptic patients. To interpret these results, we propose a model of a network of coupled chaotic maps where we calculate the complexity as a function of a parameter and relate this measure with the emergence of nontrivial collective behavior in the system. Our results show that the presence of nontrivial collective behavior is associated to high values of complexity; thus suggesting that similar dynamical collective process may take place in the human brain. Our findings also suggest that epilepsy is a degenerative illness related to the loss of complexity in the brain.Comment: 13 pages, 3 figure

El proceso de composición de la obra ciceroniana según las Cartas a Ático

En este artículo se analiza la actividad literaria de Cicerón a partir de la información contenida en sus Cartas a Ático. Concretamente, se describen las primeras etapas del proceso creativo: génesis, fuentes y composición de las obras. Se detalla, en primer lugar, la etapa en que el autor concibe la idea de escribir una obra literaria, que puede responder a razones de índole diversa; en segundo lugar, se estudian las fuentes utilizadas por Cicerón según son reveladas por las cartas que escribe a Ático; finalmente, se expone el proceso de composición del texto, ilustrado con el caso particular de redacción de los Academica

La gestualidad de la barba y el mentón en la Antigüedad romana

Beards and chins are two parts of the body that are associated with a large number of gestures. This paper examines a number of texts in which these gestures appear and the meaning they convey. The analysis was conducted by distinguishing between self-adaptor gestures (those that do not involve a second party), alter-directed adaptors (those that, to the contrary, involve the intervention of another person) and object-adaptors (a category that encompasses gestures involving an object)

A methodological proposal and tool support for the HL7 standards compliance in the development of health information systems

Health information systems are increasingly complex, and their development is presented as a challenge for software development companies offering quality, maintainable and interoperable products. HL7 (Health level 7) International, an international non-profit organization, defines and maintains standards related to health information systems. However, the modelling languages proposed by HL7 are far removed from standard languages and widely known by software engineers. In these lines, NDT is a software development methodology that has a support tool called NDT-Suite and is based, on the one hand, on the paradigm of model-driven engineering and, on the other hand, in UML that is a widely recognized standard language. This paper proposes an extension of the NDT methodology called MoDHE (Model Driven Health Engineering) to offer software engineers a methodology capable of modelling health information systems conforming to HL7 using UML domain models

Distribution of leaf photosynthesis and transpiration within grapevine canopies under different drought conditions

The effects of seasonal drought on the distribution of leaf area, photosynthesis and transpiration within the canopy were evaluated for two Spanish grapevine cultivars. Both varieties were cultivated according to their typical training system.At early stages of drought, reduction of photosynthesis and transpiration was only observed in sun-exposed leaves. As drought intensified, even less sun-exposed leaves were affected. Severe drought reduced photosynthesis and transpiration in all locations of the canopy except for most shaded leaves in the inner part. However, those leaves were almost unproductive, and seemed to be insensitive to variation of both light intensity and drought. Leaf area was also reduced by drought, but the distribution of these reductions within the canopy differed between cultivars, possibly reflecting differences in the training system.Leaves from all locations of the canopy except those in the central part showed a similar radiation use efficiency, suggesting that the observed variation in photosynthesis within the canopy was mostly related to different light interception, while other factors such as different leaf age should play only a minor role. Photosynthetic radiation use efficiency strongly depended on both, pre-dawn leaf water potential and light-saturated stomatal conductance. The interest of these results for modeling purposes is discussed.