Boosting Your Virtual Reference Use

From month to month Lansing Community College ranks number 3 in total number of questions answered, number 1 for community colleges in Research Help Now. How are we doing it? This short speech will demonstrate our marketing techniques for Virtual Reference, including library instruction, tours, our library website, Ask Us bookmarks and most recently- embedding Ask a Librarian into our course management site, Desire2Learn. This talk will emphasize the importance of embedding Ask a Librarian into our course management site, and how it has helped us to increase Virtual Reference usage and awareness

Survey says….What User Comments and Surveys Say about Research Help Now

“It was a great experience. I won\u27t hesitate to use this chat service again. It was fast, efficient and I felt connected”, is just one of the many comments we have received regarding our 24/7 chat service. This session will explore Virtual Reference user satisfaction and feedback from both our surveys and chat transcripts, emphasizing the importance of reminding patrons to fill out the QuestionPoint survey, to obtain more qualitative information. Even the occasional negative comments can help us to improve our Virtual Reference quality, library services, and the QuestionPoint software. Once a user has a positive interaction with Virtual Reference, that person is not only more likely to use the service again, but may promote the service to her/his friends. We will take a look at the types of comments our users have given us to find out what we are doing well, why users are utilizing Virtual Reference (or returning), and how we could improve the service

Prothrombin Complex Concentrate, a General Antidote for Oral Anticoagulation

Prothrombin complex concentrate (PCC) is used for the rapid reversal of vitamin K antagonist (VKA) anticoagulation. PCC is also applicable in situations requiring rapid reversal of anticoagulation by non-vitamin K antagonist direct thrombin and factor Xa inhibitor oral anticoagulants (NOACs), thereby making PCC a general antidote for oral anticoagulation. In this chapter, the composition of different PCC brands is reviewed and a negative effect of heparin supplement in some products is recognized. Mode of action of anticoagulation reversal by PCC is explained. Dosage and clinical efficacy, two closely related issues, are discussed and based on reviewed data recommendations are given that may prohibit too low PCC dosing, especially in NOAC anticoagulation. Use of unsuitable laboratory assays has raised needless controversy as to the applicability of PCC to reverse anticoagulation by NOACs, in particular dabigatran. In this chapter, various laboratory assays are evaluated for their applicability in monitoring reversal of anticoagulation

Internal Migration and Regional Population Dynamics in Europe: Estonia Case Study

Estonia has experienced a long-lasting and strong influence of international migration on regional population growth. Post-war immigrants account for about 36 per cent of the total population, and are concentrated in larger cities of Northern Estonia. Regionally, the relative proportions of the native-born and immigrant origin sub-populations are important for the understanding of population change and internal migration flows in the 1980-1990s. In Estonia, the quality of migration data requires careful assessment. The preservation of Soviet-type record-keeping has reduced data quality in the 1990s, already low, and use of the data should keep data quality problems in mind. Otherwise, false conclusions can be reached. To describe internal migration patterns, it has proved technically feasible and very useful to disaggregate the county population into rural and urban components, and correspondingly, the migration flows into four directions (urban-urban, urban-rural, rural-urban and rural-rural). During the 1980s the pattern of population growth and internal migration has changed in Estonia. Reflecting the turnaround in long-term population processes, migration development reached the advanced stage with more or less regionally balanced in- and out-migration flows and decreasing importance of net migration. Accordingly, to understand current trends and patterns, explanations must be sought from the 1980s which has served a starting point for the present trends rather than from the period of economic transition in the 1990s. As a part of the turnaround, the century-long persistent rural depopulation has come to an end and the moderate growth has started reflecting natural population increase as well as deurbanization. In the 1980s two developments have occurred in parallel: migratory increase of rural population led by a deurbanizing native-born population, and continued urban population growth as a result of the population momentum of pre-transition immigrants. In future decades, the urban deconcentration will probably be the underlying trend in Estonia. In Estonia, noticeable proportion of territory and population is located in islands. However, the island population does not show any systematic difference in the type of internal migration. Particularly, the depopulation of island populations, observed in several comparable European cases, is not occurring. Each life-course stage was found to have its specific migration pattern, more stable than the pattern for the total population. In many cases the changes of internal migration are determined by the change in the proportion of population in different life-course stages. Additionally, the life-course approach has been useful in demonstrating the features of the present Estonian internal migration pattern which appear closer to the countries of comparable in demographic development, more or less regardless of the significant differences in the level of economic development. Among life-course groups, in Estonia the older working age population was characterized by the strongest deurbanization intensities in 1995. The same group has also undergone the largest modification of migration pattern during the economic transition (1987-1995)

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The cross-sectional resistance of square and rectangular hollow steel sections loaded by bending moment and shear force

This paper presents an evaluation of the design rules for the bending moment–shear force (M−V) interaction of cold- and hot-formed square, and rectangular hollow steel sections (SHS &amp; RHS). More specifically, the design rules, as provided by EN1993-1-1 regarding RHS and SHS of section class 1 and 2 are covered for the steel grades S235 up to and including S460. A 4-point bending test was simulated by means of a finite element model, which was validated on the basis of experimental tests from existing literature. A parametric study was performed and numerical M−V interaction results were compared to the provisions in EN1993-1-1. This comparison indicates that the current design rules in EN1993-1-1 regarding M−V interaction are conservative and overestimate the reduction of the bending resistance due to the presence of shear. Alternative design rules for the shear area and M−V interaction of RHS and SHS are proposed and evaluated by means of a statistical assessment procedure based on existing literature and EN1990-1-1. Both newly developed design rules are shown to ensure an adequate reliability level when a partial safety factor equal to 1 is used.</p

Intraprofessional Nursing Communication and Collaboration: APN-RN-Patient Bedside Rounding

Executive Summary Leading advisory agencies have long advocated that health care must be safe and effective (Institute of Medicine [IOM], 2001). In order for health care to be safe and effective, good communication and collaboration are essential. Research has found that in health care, poor communication and teamwork failures are the major contributors to adverse events (Cornell, Townsend-Gervis, Vardaman, & Yates, 2014; The Joint Commission, 2011; O’Leary, 2012). Such communication-related adverse events can cause avoidable injury, loss of life, and financial devastation. In light of advanced practice nurses’ (APN) increasing contribution in care management, and in order to ensure delivery of high-quality patient care, hospital administrators and nurse executives in particular, must foster improved communication and collaboration between APNs and RNs. The potential benefits of improving APN–RN teamwork are multiple. For example, Naylor et al. (2013) have reported that, in their study, nurse-led interdisciplinary interventions resulted in quality improvement and cost savings. One solution for improving communication within the health care team pertains to bedside rounding. Daily bedside rounding presents an opportunity for care team members to cooperatively develop and communicate care strategies. Staff nurses are typically not included in physician led patient rounds. This exclusion is unfortunate because, during rounds, nurses could provide essential nursing expertise and knowledge about patients’ health status; furthermore, nurses are uniquely positioned to encourage patients’ proactive participation in their own health care team. The primary objective of the DNP project described in this doctoral project paper was to develop a structured learning module to improve collaboration and communication between APNs and RNs through the implementation of APN–RN patient bedside rounding. To establish a basis for creating the learning module, the DNP project began with an in-depth literature review of research on (a) APN–clinical nurse communication and collaboration and (b) the contributions of APNs and clinical nurses to the quality of patient care. Evidence-based best practice recommendations guided the development of the learning module to instruct APN and clinical nursing staff on proper communication and collaboration in conjunction with the use of a daily goals sheet to facilitate structured APN–RN–patient beside rounding. (For example, the use of bedside rounding with daily goal reminder sheets has demonstrated improved communication in patient-centered care.) King goal attainment theory provided the underpinning for this project with Knowles’ conceptual framework of andragogy provided a methodology, framework, and mechanism that informed the learning module’s design. After an initial draft of the module was completed, it was sent to three of the hospital’s APNs for their review; all of these APNs had had prior experience with APN–RN rounding at other hospitals. Following the APN’s review, the main modifications of the learning module included expanding the explanations of (a) breakdown of communication (specifically, nonverbal communication), (b) roadblocks to collaboration, and (c) inclusion of the patient’s family in rounding discussions, when possible discussion, when possible. Bedside rounding presents a daily opportunity for health care team members to cooperatively strategize and to communicate the plan and goals of care to the patient and family; this cooperative activity reflects a concerted team effort to achieve the patient’s goals. Effective communication and collaboration are requisite for building a patient centered care partnership. The learning module developed in this DNP project can assist APNs and RNs in improving their communication and collaboration