CNL as Outcomes Manager: Improving Communication During the ER to ICU Handoff

Emergency room (ER) to Intensive care unit (ICU) handoff reports are often ineffective because the lack of an standardized guideline. The aim of the Clinical Nurse Leader (CNL) improvement project was to improve the nurse satisfaction survey scores in the ER and ICU microsystems within a mid-sized community hospital in northern California. Participates included registered nurses, and ER and ICU managers. The failure mode and effect analysis (FMEA), Strength, weaknesses, opportunities, and threats (SWOT) analysis, and the Plan-Do-Study-Act (PDSA) cycle were used for this project. Literature reviews were conducted to identify effective theories, patterns, and tools for handoff reports. Nurse surveys were conducted to evaluate their satisfaction with handoff reports before and after the quality improvement project. A handoff guide was developed that was influenced by nursing feedback for implementation. Although the goal of improving survey results by 30% following two weeks of project implementation was not achieved, nurse satisfaction still greatly improvedby 23% from 54% to 77%. Identification and implementation of a standardized handoff report guide improved nurse satisfaction within the microsystems of ER and ICU. Additional work is needed to ensure 100% compliance and reassessment after long term usage

Effects of practice variability on learning of relaxed phonation in vocally hyperfunctional speakers

Thesis (B.Sc)--University of Hong Kong, 2008.Also available in print.Includes bibliographical references (leaves 27-30).A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, June 30, 2008.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

Characterizing the overlap between SLI and dyslexia in Chinese: The role of phonology and beyond

This study examined the overlap of dyslexia and specific language impairment (SLI) in Cantonese-Chinese-speaking children. Thirty children with a prior diagnosis of SLI and 9 normal controls, aged between 6;0 and 11;3, participated. The children with SLI were tested for language impairment and dyslexia. Seven retained a diagnosis of SLI but were dyslexia-free (SLI-only), 13 received a comorbid diagnosis of dyslexia (SLI-D), and SLI had become history (SLI-H) in the other 10 children with no co-morbid diagnoses of dyslexia. The SLI-only group did worse on textual comprehension, but better on left-right reversal (an orthographic skill), than the SLI-D group. The SLI-only and the SLI-D group shared the same range of cognitive deficits relative to age norms and showed no difference in phonological processing. The SLI-D group did worse than the normal group on phonological representation, and both the SLI-only and the SLI-D group had difficulties with morphological awareness. © 2010 Society for the Scientific Study of Reading.postprin

Apathy, cognitive impairment, and social support contribute to participation in cognitively demanding activities poststroke

Importance. Individuals with chronic stroke experience decreased participation in activities with cognitive demands across all areas of occupation. Objective. To understand the extent to which apathy, cognition, and social support predict participation in activities with cognitive demands. Design. Prospective, quantitative correlational, cross-sectional study. Setting. Outpatient treatment centers and community stroke support groups located in St. Louis, MO, and Boston, MA. Participants. 81 community-dwelling individuals≥6-month poststroke with and without aphasia. Measures. Participants completed the Activity Card Sort (ACS), Apathy Evaluation Scale (AES), Medical Outcomes Study Social Support Survey (MOS-SSS), and Delis-Kaplan Executive Function System (DKEFS) Design Fluency and Trail-Making subtests. Results. Cognitive deficits limit participation in activities with high cognitive demands. Apathy and positive social interaction influence participation, regardless of high or low cognitive demands. Poststroke aphasia did not impact return to participation in activities with high and low cognitive demands. Conclusions and Relevance. Cognitive deficits seen poststroke contribute to participation only for activities with high cognitive demands. Apathy has a significant and negative influence on participation overall. Social support is a modifiable contextual factor that can facilitate participation. Poststroke apathy can be detrimental to participation but is not well recognized. The availability of companionship from others to enjoy time with can facilitate participation

A fossil-calibrated time-tree of all Australian freshwater fishes

Australian freshwater fishes are a relatively species-poor assemblage, comprising a small number of Gondwanan lineages and a number of groups derived from repeated freshwater invasions by marine ancestors. In addition to being a comparatively small assemblage, they are both highly endemic and highly threatened. However, a comprehensive phylogeny for these taxa is lacking, which has hampered efforts to study their phylogenetic diversity, distribution of extinction risk, speciation rate, and rates of trait evolution. Here, we present a comprehensive dated phylogeny of 412 Australian freshwater fishes. We include all formally recognized freshwater species plus a number of genetically distinct subpopulations, species awaiting formal description, and predominantly brackish-water species. The phylogeny was inferred using maximum-likelihood analysis of a multilocus data set comprising six mitochondrial and three nuclear genes from 326 taxa. We inferred the evolutionary timescale using penalized likelihood, then used a statistical approach to add 86 taxa for which no molecular data were available. The time-tree inferred in our study will provide a useful resource for macroecological studies of Australian freshwater fishes, by enabling corrections for phylogenetic non-independence in evolutionary and ecological comparative analyses

Overexpression, purification and characterization of potential iron-trafficking proteins from a phenol-degrading pseudomonad

Frataxin is a small protein implicated in intracellular and mitochondrial iron trafficking. Some studies of frataxin have suggested that it can act as an iron donor for iron-sulfur cluster assembly and heme assembly. We are interested in iron-binding proteins involved in phenol degradation by Pseudomonas sp. strain CF600, and the possible involvement of frataxin and other proteins in their assembly. One of the goals of this research was to overexpress, purify, and to characterize the stability, metal iron binding properties, and subunit structure of CyaY, the frataxin homologue from Pseudomonas sp. strain CF600. CyaY was successfully overexpressed and CyaY purified to homogeneity using Fast-Flow DEAE-Sepharose, Sephacryl S-300HR Gel Filtration, and High-Performance Phenyl Sepharose chromatographies. Analytical ultracentrifugation studies indicated that CyaY exists mainly as a monomer and that it does not aggregate in the presence of Fe(II). Isothermal titration calorimetry results were consistent with the binding of 1 Fe(II) or 1 Mn(II) per monomer of CyaY, with Fe(II) binding with a higher affinity. These and other results were similar to the reported iron-binding properties of CyaY from E. coli . Additional studies showed that CyaY significantly retarded oxidation of Fe(II), helping to keep it available for incorporation into other proteins. A second goal was to overexpress and purify a putative iron-sulfur protein (CyaZ) that is encoded in the Pseudomonas putida genome adjacent to CyaY. This was successfully accomplished, and the resulting preparation appears to contain an iron-sulfur cluster. As was demonstrated for CyaY, CyaZ significantly retarded oxidation of Fe(II) in the presence of both proteins. CyaY and CyaZ are currently being tested for their ability to affect assembly of iron-containing proteins involved in phenol degradatio

(Dis)connections between specific language impairment and dyslexia in Chinese

Poster Session: no. 26P.40Specific language impairment (SLI) and dyslexia describe language-learning impairments that occur in the absence of a sensory, cognitive, or psychosocial impairment. SLI is primarily defined by an impairment in oral language, and dyslexia by a deficit in the reading of written words. SLI and dyslexia co-occur in school-age children learning English, with rates ranging from 17% to 75%. For children learning Chinese, SLI and dyslexia also co-occur. Wong et al. (2010) first reported on the presence of dyslexia in a clinical sample of 6- to 11-year-old school-age children with SLI. The study compared the reading-related cognitive skills of children with SLI and dyslexia (SLI-D) with 2 groups of children …postprin

Epithelial Migration and Non-adhesive Periderm Are Required for Digit Separation during Mammalian Development.

The fusion of digits or toes, syndactyly, can be part of complex syndromes, including van der Woude syndrome. A subset of van der Woude cases is caused by dominant-negative mutations in the epithelial transcription factor Grainyhead like-3 (GRHL3), and Grhl3-/-mice have soft-tissue syndactyly. Although impaired interdigital cell death of mesenchymal cells causes syndactyly in multiple genetic mutants, Grhl3-/- embryos had normal interdigital cell death, suggesting alternative mechanisms for syndactyly. We found that in digit separation, the overlying epidermis forms a migrating interdigital epithelial tongue (IET) when the epithelium invaginates to separate the digits. Normally, the non-adhesive surface periderm allows the IET to bifurcate as the digits separate. In contrast, in Grhl3-/- embryos, the IET moves normally between the digits but fails to bifurcate because of abnormal adhesion of the periderm. Our study identifies epidermal developmental processes required for digit separation

Diagnostic Accuracy of Delirium Assessment Tools in Critical Ill Patients: A Systematic Review and Meta-analysis

Abstract presented at The Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting, 13-15 May 2019, Adelaide, Australi