A Comparative Study of Central Supply Services Administered Under Nursing and Non-nursing Management

The purpose of this study was to determine, on the basis of opinions of head nurses, directors of nursing service and hospital administrators, whether a central supply service could be operated as efficiently under non-nursing administrative control as it could be under the control of the nursing department. The normative-survey method of research was used for the investigation of the problem and the tool utilized for gathering the data was the questionnaire. Two questionnaires were constructed. One, which requested background information as well as opinions, was submitted to directors of nursing service in twenty-five hospitals in which the central supply service functioned under the nursing department and to hospital administrators in twenty-five hospitals in which the central supply service functioned under a non-nursing department. The second questionnaire, which elicited opinions was sent to four head nurses in each one of the fifty hospitals. The opinions of the head nurses indicated that those who worked with the central supply functioning under a non-nursing department were just as satisfied with the services they received as those who worked with it under the nursing department. The study showed that directors of nursing service tend to regard the management of the central supply as a vital nursing function. Hospital administrators tend to regard the management of the central supply as a complex, specialized operation and to believe that the graduate nurse should devote her knowledge and skill to more direct nursing care activities. The overall results of this study indicate that central supply departments administered under non-nursing management render as efficient service as do central supply departments administered by the nursing service

El modelo SERVQUAL para medir la calidad en el servicio al cliente

Este trabajo de graduación recopila información actualizada sobre el mercadeo estratégico de servicios, desde el enfoque de una propuesta competitiva en términos de la calidad como elemento de diferenciación. Por consiguiente, surge el tema de cuantificar y medir la calidad en forma tal que la empresa pueda tomar parte activa en el desarrollo de estrategias que mejoren su oferta de servicios. El trabajo parte de aspectos generales que cobran importancia desde el punto de vista macroeconómico que inciden en el desempeño de la empresa. La perspectiva del entorno que encontramos en este trabajo nos ubica en el mapa de competencia internacional, presenta cifras que ponderan la importancia del sector servicios en la economía panameña y la oportunidad competitiva en comparación con los acontecimientos internacionales que nos afectan directamente. Se evalúa el papel de Panamá en el concierto de naciones desde el punto de vista del comercio internacional, y su propuesta de servicios como oportunidad de desarrollo y promoción futura. También se integran aspectos relacionados con el mercadeo estratégico de servicios, hecho que ha cobrado vigencia recientemente dados los últimos avances del mercado por parte de los consumidores que adquieren cada vez más poder de cambio y cuya reacción es decisiva en determinar el futuro éxito de cualquier empresa. Los consumidores están cada día más informados, tienen mayor acceso a productos homogéneos que son difíciles de diferenciar y las empresas que han logrado el éxito ondean la bandera de la calidad como su mejor activo. Pero, ¿Cómo sabemos si nuestra empresa cuenta con la satisfacción de lo que el común de nuestros clientes espera? ¿Conocemos cuáles son los aspectos que han logrado la preferencia de nuestros clientes? ¿Sabemos qué nos hace falta para satisfacer a nuestros clientes y ganarnos el privilegio de ser los primeros en su mente? El Método SERVQUAL, es un método de investigación de mercados que ha demostrado ser efectivo para medir las variables que definen la calidad en el servicio, considerando las características propias de un producto intangible. Al utilizar el método SERVQUAL, como instrumento de investigación de mercado en una empresa local de servicios, podremos dirigir una estrategia de mercadeo orientada a mejorar la calidad en el servicio al cliente

INTERSEX AND THE RIGHT TO IDENTITY: A DISCOURSE ON THE CIVIL RECORD OF INTERSEX CHILDREN

Law interacts with intersex in humans from the perspective of gender identity, as a sub-aspect of the right to identity. Intersex is a condition affecting the growth and development of children. The diagnosis, sometimes delayed because of the need for specific exams, has a direct effect on gender and name definition, as reflected on a child’s civil record. In this sense, the purpose of this article is to examine the intersex children’s guarantee to the right to identity, from the perspective of the civil birth record as a human right. To this end, interviews were conducted with legal professionals working with childhood, family or public registry issues. The interviews generated opinions on the guarantee to the right to identity for these children, under the present Brazilian Law of Public Records. As a result, speeches converged on the anachronism in this law, as well as the need for legal changes to preserve the children’s dignity. The intersex newborn’s right to identity is a subject that demands interaction among various areas of knowledge and practice to effectively guarantee the best interests of the child.O Direito articula-se com o tema da intersexualidade humana a partir da identidade sexual como um subaspecto do direito humano à identidade. A intersexualidade constitui uma circunstância que afeta ocrescimento e o desenvolvimento da criança. O diagnóstico, por vezes retardado em face da necessidade de exames específicos, implica diretamente na definição do sexo e do nome, afetando o assentamento civil da criança. Neste sentido, o presente artigo visa analisar a garantia do direito à identidade da criança com intersexo na perspectiva do Registro Civil de Nascimento, enquanto Direito Humano. Para tanto, foram realizadas entrevistas com profissionais do direito que trabalham nas áreas da infância, família ou registro público. A entrevista levantou opiniões sobre a garantia do direito à identidade destas crianças em face da Lei de Registros Públicos vigente no Brasil. Como resultado, os discursos convergiram para o anacronismo da referida norma e para a necessidade de uma modificação legal a fim de resguardar a dignidade das crianças intersexuadas. O direito à identidade do recém-nascido com intersexo constitui um tema que demanda interlocução com várias áreas do saber e da prática para efetiva garantia do melhor interesse da criança

The transitional gap transient AT 2018hso: new insights into the luminous red nova phenomenon

Context. The absolute magnitudes of luminous red novae (LRNe) are intermediate between those of novae and supernovae (SNe), and show a relatively homogeneous spectro-photometric evolution. Although they were thought to derive from core instabilities in single stars, there is growing support for the idea that they are triggered by binary interaction that possibly ends with the merging of the two stars. Aims. AT 2018hso is a new transient showing transitional properties between those of LRNe and the class of intermediate-luminosity red transients (ILRTs) similar to SN 2008S. Through the detailed analysis of the observed parameters, our study supports that it actually belongs to the LRN class and was likely produced by the coalescence of two massive stars. Methods. We obtained ten months of optical and near-infrared photometric monitoring, and 11 epochs of low-resolution optical spectroscopy of AT 2018hso. We compared its observed properties with those of other ILRTs and LRNe. We also inspected the archival Hubble Space Telescope (HST) images obtained about 15 years ago to constrain the progenitor properties. Results. The light curves of AT 2018hso show a first sharp peak (reddening-corrected M-r = -13.93 mag), followed by a broader and shallower second peak that resembles a plateau in the optical bands. The spectra dramatically change with time. Early-time spectra show prominent Balmer emission lines and a weak [Ca II] doublet, which is usually observed in ILRTs. However, the strong decrease in the continuum temperature, the appearance of narrow metal absorption lines, the great change in the H alpha strength and profile, and the emergence of molecular bands support an LRN classification. The possible detection of a M-I similar to -8 mag source at the position of AT 2018hso in HST archive images is consistent with expectations for a pre-merger massive binary, similar to the precursor of the 2015 LRN in M101. Conclusions. We provide reasonable arguments to support an LRN classification for AT 2018hso. This study reveals growing heterogeneity in the observables of LRNe than has been thought previously, which is a challenge for distinguishing between LRNe and ILRTs. This suggests that the entire evolution of gap transients needs to be monitored to avoid misclassifications

The Chemogenetic Receptor Ligand Clozapine N-Oxide Induces<em> in vivo</em> Neuroreceptor Occupancy and Reduces Striatal Glutamate Levels

Chemogenetic studies with the ligand clozapine N-oxide (CNO) are predicated upon the assumption that CNO is devoid of actions at natural neuroreceptors. However, recent evidence shows that CNO may be converted back to clozapine (CLZ) in vivo, which could yield plasma concentrations that may be sufficient to occupy inter alia dopamine D2=3 and serotonin 5HT2A receptors in living brain. To test this phenomenon, we measured striatal dopamine D2=3 receptor occupancy with [18F]fallypride PET and serotonin 5HT2A occupancy ex vivo using [18F]MH.MZ. We found a CNO dosedependent effect on the availability of both neuroreceptor sites. In parallel MR spectroscopy experiments, we found that CNO reduced creatine C phosphcreatine (CrCPCr) and increased N-acetylaspartate C N-acetylaspartylglutamate (NAACNAAG) signals in the prefrontal cortex, and also reduced the glutamate signal in dorsal striatum, with peak effect at 2 mg/kg. Thus, our findings suggest that conversion of CNO to CLZ in living rats imparts significant occupancy at endogenous neuroreceptors and significant changes to neurometabolite levels

Critical implications of IVDR for innovation in diagnostics: input from the BioMed alliance diagnostics task force

With the implementation of Regulation (European Union [EU]) 2017/746 on in vitro diagnostic medical devices (IVDR), from May 26, 2022, onwards, the development and use of diagnostic tests will be governed by a vastly expanded and upgraded EU regulatory framework. We provide here an overview of the amended transition timelines, the role of notified bodies, EU reference laboratories, expert panels, and the Medical Device Coordination Group (MDCG). We also describe the implications of the IVDR for innovative laboratory medicine by explaining the exemption for in-house devices (IH-IVDs). Two key challenges faced by the academic diagnostic sector are: (1) the stipulation on equivalence of tests (article 5.5d), which poses a new condition for the use of IH-IVDs and (2) the gray area between CE marked in vitro diagnostics (CE-IVDs), modified CE-IVDs, Research Use Only (RUO) tests, and IH-IVDs. Furthermore, the results of a questionnaire on current diagnostic practice conducted by European medical societies collaborating in the BioMed Alliance indicate widespread use of IH-IVDs in diagnostic laboratories across Europe and emphasize the need for support and guidance to comply with the IVDR. Diagnostic equivalents of the European Reference Networks (ERNs) for rare diseases could help ensure affordable and equal access to specialized diagnostics across the EU. Concerted action by clinical and laboratory disciplines, regulators, industry, and patient organizations is needed to support the efficient and effective implementation of the IVDR in a way that preserves innovation and safeguards the quality, safety, and accessibility of innovative diagnostics.Peer reviewe

The long-lived Type IIn SN 2015da: Infrared echoes and strong interaction within an extended massive shell star star star

In this paper we report the results of the first similar to four years of spectroscopic and photometric monitoring of the Type IIn supernova SN 2015da (also known as PSN J13522411+3941286, or iPTF16tu). The supernova exploded in the nearby spiral galaxy NGC 5337 in a relatively highly extinguished environment. The transient showed prominent narrow Balmer lines in emission at all times and a slow rise to maximum in all bands. In addition, early observations performed by amateur astronomers give a very well-constrained explosion epoch. The observables are consistent with continuous interaction between the supernova ejecta and a dense and extended H-rich circumstellar medium. The presence of such an extended and dense medium is difficult to reconcile with standard stellar evolution models, since the metallicity at the position of SN 2015da seems to be slightly subsolar. Interaction is likely the mechanism powering the light curve, as confirmed by the analysis of the pseudo bolometric light curve, which gives a total radiated energy greater than or similar to 10(51) erg. Modeling the light curve in the context of a supernova shock breakout through a dense circumstellar medium allowed us to infer the mass of the prexisting gas to be similar or equal to 8 M-circle dot, with an extreme mass-loss rate for the progenitor star similar or equal to 0.6 M-circle dot yr(-1), suggesting that most of the circumstellar gas was produced during multiple eruptive events. Near- and mid-infrared observations reveal a fluxexcess in these domains, similar to those observed in SN 2010jl and other interacting transients, likely due to preexisting radiatively heated dust surrounding the supernova. By modeling the infrared excess, we infer a mass greater than or similar to 0.4 x 10(-3) M-circle dot for the dustSpanish MICINN gran

Bio-inspired polydopamine layer as a versatile functionalisation protocol for silicon-based photonic biosensors

Photonic biosensors have made major advances in recent years, achieving very high sensitivity, and progressing towards point-of-care deployment. By using photonic resonances, sensors can be label-free, which is particularly attractive for a low-cost technological realisation. A key remaining issue is the biological interface and the efficient and reliable immobilisation of binder molecules such as antibodies; many protocols are currently in use that have led to widely varying sensor performance. Here, we study a very simple and robust surface functionalisation protocol for silicon photonics, which is based on polydopamine, and we demonstrate both its simplicity and its high performance. The use of polydopamine (PDA) is inspired by molluscs, especially mussels, that employ dopamine to adhere to virtually any surface, especially in an aqueous environment. We studied the versatility of the PDA protocol by showing compatibility with 5 different disease biomarkers (Immunoglobulin (IgG), C-reactive protein (CRP), Tumour Necrosis factor-α (TNF-α), Interleukin-6 (IL-6), Matrix metalloproteinase (MMP-9) and show that the protocol is resistant to hydrolysis during incubation; the loss of functionality due to hydrolysis is a major issue for many of the functionalisation protocols commonly used for silicon-based sensors. The study using guided mode resonance-based sensors highlights the wide dynamic range of the protocol (0.01 ng/mL to 1 μg/mL), using IgG, CRP and MMP-9 protein biomarkers as exemplars. In addition, we show that the surface chemistry allows performing measurements in 10% human serum with a sensitivity as low as 10 ng/mL for IgG. We suggest that adopting this protocol will make it easier for researchers to achieve biofunctionalisation and that the biosensor community will be able to achieve more consistent results

Extended Kalman Filtering Projection Method to Reduce the 3σ Noise Value of Optical Biosensors

Optical biosensors have experienced a rapid growth over the past decade because of their high sensitivity and the fact that they are label-free. Many optical biosensors rely on tracking the change in a resonance signal or an interference pattern caused by the change in refractive index that occurs upon binding to a target biomarker. The most commonly used method for tracking such a signal is based on fitting the data with an appropriate mathematical function, such as a harmonic function or a Fano, Gaussian, or Lorentz function. However, these functions have limited fitting efficiency because of the deformation of data from noise. Here, we introduce an extended Kalman filter projection (EKFP) method to address the problem of resonance tracking and demonstrate that it improves the tolerance to noise, reduces the 3σ noise value, and lowers the limit of detection (LOD). We utilize the method to process the data of experiments for detecting the binding of C-reactive protein in a urine matrix with a chirped guided mode resonance sensor and are able to improve the LOD from 10 to 1 pg/mL. Our method reduces the 3σ noise value of this measurement compared to a simple Fano fit from 1.303 to 0.015 pixels. These results demonstrate the significant advantage of the EKFP method to resolving noisy data of optical biosensors

Legionellosis Outbreak Associated with Asphalt Paving Machine, Spain, 2009

TOC Summary: The source was untreated spring water in the machine’s water tank