Quality safety assessment/application for nurses (QSAAN)

Healthcare quality and safety carries the burden of perfection in a complex, imperfect practice environment. Healthcare has identified quality and safety as a priority (Institute of Medicine, 1999; Institute of Medicine, 2011).Currently, application of Quality Safety Education for Nurses (QSEN) competencies is seen primarily within academic settings and has been studied in one segment of practicing nurses - pediatric oncology nurses (Dycus & McKeon, 2009). Practicing nurses should be able to identify and demonstrate the competencies of knowledge, skills and attitudes within the six domains of QSEN. Purpose: This three prong study measured the knowledge, skills and attitudes of practicing nurses compared to QSEN competencies; conducted psychometric evaluation of a tool to measure translation of QSEN into practice; and provided feedback to community academic partners about QSEN competencies in the practice setting. Methodology: In January 2012, nurses at four acute care facilities were invited to participate in a survey study utilizing the Quality Improvement Knowledge, Skills and Attitudes (QUISKA2) tool (n = 2060). This descriptive survey study replicated and expanded the work of Dycus and McKeon (2009) by changing participants to nurses in various acute care clinical settings and organizational roles. Descriptive statistics and correlation between nursing role, academic degree, certification, unit of work, previous quality improvement education and years from nursing education and the QSEN domains were conducted. Pearson’s r for interval data of skills and MANOVA for comparison of three groups of leadership responses were completed. Psychometric tests included correlation between the various roles of nurses in the acute care setting in the expected competencies, frequencies of the items, internal consistency using Cronbach’s alpha, and an inter-item correlation coefficient. Results: The QUISKA2 is a valid and reliable tool for measuring the knowledge, skills, and attitudes of practicing nurses at the three levels of nurses in the acute care practice setting. There is statistically higher scores and proficiency dependent upon the nursing role (p \u3c 0.001), academic degree (p \u3c 0.001), certification (p = 0.015) and the presence of previous QI training (p \u3c 0.001). Nurses within the acute care setting are most familiar with QSEN domains of Patient Centered Care (5.5) and Teamwork and Collaboration (4.9) and less familiar with Quality Improvement (3.4) and Evidenced Based Practice (3.3) based on a scale of 1 to 6. Practice Implications: Identification of quality safety outcomes benefits patients, practicing nurses and healthcare facilities through standardized assessment of nursing competencies. This work builds the foundation for translation of QSEN into the practice setting in partnership with community academic institutions. Future research is planned for 2013 to expand applicability of the QUISKA2 tool in other practice settings. A common quality safety competency language grounded in theory, research and practice elevates the discipline

Sharing a home under lockdown in London

Since the beginning of the pandemic, there has been a wave of research into the interaction of Covid-19 and housing. This study examines the experience of adult sharers, using qualitative evidence from an online survey, during the early months of the pandemic. This contributes to the evidence about housing quality particularly the adaptability and flexibility of the dwelling and wellbeing under the pressures of lockdown. Few homes were built to perform the multiple functions leisure and work, particularly London homes-- which are the smallest in the country in terms of floor area per inhabitant. As office-based work shifted to the home in the early stages of lockdown, adult sharers faced a range of practical and spatial challenges. Those working from home had to reconsider (and sometimes reconfigure) their homes as workspaces, and negotiate the use of space with fellow residents. Many ‘solutions’ were deemed inadequate and lockdown conditions generated interpersonal tensions in many sharer households, but strengthened bonds in others. The pandemic changed sharers’ aspirations for their future housing. The findings are relevant for planning and housing policy, including standards for new-build residential units and the requirements for existing Houses in Multiple Occupation (HMO)

Anthrax lethal toxin induced lysosomal membrane permeabilization and cytosolic cathepsin release is Nlrp1b/Nalp1b-dependent.

NOD-like receptors (NLRs) are a group of cytoplasmic molecules that recognize microbial invasion or 'danger signals'. Activation of NLRs can induce rapid caspase-1 dependent cell death termed pyroptosis, or a caspase-1 independent cell death termed pyronecrosis. Bacillus anthracis lethal toxin (LT), is recognized by a subset of alleles of the NLR protein Nlrp1b, resulting in pyroptotic cell death of macrophages and dendritic cells. Here we show that LT induces lysosomal membrane permeabilization (LMP). The presentation of LMP requires expression of an LT-responsive allele of Nlrp1b, and is blocked by proteasome inhibitors and heat shock, both of which prevent LT-mediated pyroptosis. Further the lysosomal protease cathepsin B is released into the cell cytosol and cathepsin inhibitors block LT-mediated cell death. These data reveal a role for lysosomal membrane permeabilization in the cellular response to bacterial pathogens and demonstrate a shared requirement for cytosolic relocalization of cathepsins in pyroptosis and pyronecrosis

Community-acquired pneumonia in children: cell-free plasma sequencing for diagnosis and management.

Community-acquired pneumonia (CAP) is a common cause of pediatric hospital admission. Empiric antibiotic therapy for hospitalized children with serious CAP now targets the most likely pathogen(s), including those that may demonstrate significant antibiotic resistance. Cell-free plasma next-generation sequencing (CFPNGS) was first made available for Pediatric Infectious Diseases physicians in June 1, 2017, to supplement standard-of-care diagnostic techniques. A retrospective chart review was performed for children hospitalized with CAP between June 1, 2017, and January 22, 2018, to evaluate the impact of CFPNGS. We identified 15 hospitalized children with CAP without other underlying medical conditions for whom CFPNGS was performed. CFPNGS identified a pathogen in 13 of 15 (86%) children compared with 47% for those using standard culture and PCR-based methods alone. Changes in antibiotic management were made in 7 of 15 (47%) of children as a result of CFPNGS

The effects of dyad reading and text difficulty on third-graders’ reading achievement

This study replicated, with modifications, previous research of dyad reading using texts at various levels of difficulty (Morgan, 1997). The current project measured the effects of using above–grade-level texts on reading achievement and sought to determine the influences of dyad reading on both lead and assisted readers. Results indicate that weaker readers, using texts at two, three, and four grade levels above their instructional levels with the assistance of lead readers, outscored both proficient and less proficient students in the control group across multiple measures of reading achievement. However, the gains made by assisted readers were not significantly different relative to the various text levels. When all assessments were considered, assisted readers reading texts two grade levels above their instructional levels showed the most robust gains in oral reading fluency and comprehension. Lead readers also benefited from dyad reading and continued their respective reading developmental trajectories across measures

Health service experiences and preferences of frail home care clients and their family and friend caregivers during the COVID-19 pandemic

Objective: The COVID-19 pandemic has brought about a major upheaval in the lives of older adults and their family/friend caregivers, including those utilizing home care services. In this article, we focus on results from a qualitative component added to a pragmatic randomized controlled trial that focuses on the experiences of our study participants during COVID-19. A total of 29 participants responded to the COVID-19 related questions focused on their health services experiences and preferences from March-June 2020 including 10 home care clients and 19 family/friend caregivers in the provinces of Ontario and Nova Scotia, Canada. Results: Many participants were affected drastically by the elimination or reduction of access to services, highlighting the vulnerability of home care clients and their caregivers during COVID-19. This took an emotional toll on home care clients and increased the need for family/friend caregiver support. While many participants expressed reduced desire to utilize residential long-term care homes, some caregivers found that passive remote monitoring technology was particularly useful within the COVID-19 context. Our results provide important insights into the ways the older adults and their caregivers have been affected during the COVID-19 context and how to better support them in the future

Assisting Mid-Atlantic Wine Industry Stakeholders in Developing Consumer-Centric Marketing Strategies: Internet Survey Results

Two Internet surveys were administered to wine consumers in New Jersey, New York, and Pennsylvania. Purchasing frequencies, consumption occasions, and sources used to learn about wine were documented. National data are readily available; however, the study discussed in this article focused on Mid-Atlantic consumers, whose behaviors and attitudes were not well understood. These data provide Extension personnel in the region with the ability to better inform industry members about their clientele and help them develop marketing strategies that appeal to local wine drinkers

How Distress Tolerance Mediates the Relationship Between Posttraumatic Stress Disorder and the Interpersonal Theory of Suicide Constructs in a U.S. Military Sample

Objectives Despite the general suicide rate within the military being comparable to the general population when comparing peers, there are certain branches of the military that have elevated risk. Specifically, the U.S. National Guard has suicide rates that are constantly higher than other military branches and civilian peers. The National Guard are a unique military population in which they frequently transition between military and civilian life. With these unique experiences and heightened risk, military suicide prevention efforts may benefit from further research within this population. Posttraumatic stress disorder (PTSD) is another concern amongst military personnel and has been linked to suicidal behavior. Methods The current study examined the indirect effects that distress tolerance, a protective factor against suicide, has on the relationship between PTSD and constructs within a well‐validated theory for suicide (the Interpersonal‐Psychological Theory for suicidal behaviors) in a sample of U.S. Army National Guard personnel. Results Results indicated that distress tolerance had a significant indirect effect on the relationship between PTSD and thwarted belongingness, perceived burdensomeness, and capability for suicide. Conclusions These findings are consistent with previous literature examining the relationship between distress tolerance and our outcome variables. These results could have important clinical implications, mainly that intervention strategies targeting distress tolerance could have significant impacts on suicide‐relate thoughts

Construction of a thiF genetic disruption in Bacillus subtilis

The goal of our research is to determine whether the level of transcription of a gene is correlated with the level of mutation in that gene. One factor involved in the mutability of a transcribed gene is the ability of the single stranded DNA to form secondary stem loop structures (SLS), in the wake of the transcription bubble, that contain unpaired mutable bases. We are interested in correlating the levels of mutation with transcription in the thiF gene, which is predicted by bioinformatic analysis to be highly mutable. To achieve this goal, Kathleen will first construct a non-polar thiF genetic knockout using a chloramphenicol cassette. Then, she will test the phenotype of the ThiF- strain. She will also build an IPTG-inducible construct containing thiF with a stop codon in the loop of a putative SLS. This will be introduced into ThiF- Bacillus subtilis and assayed for the accumulation of Thy+ mutations under starvation conditions, in the presence and absence of IPTG