Mangomoments - Preconditions and impact on patients and families, healthcare professionals and organisations: A multi-method study in Flemish hospitals

Objective Understanding how small unexpected acts or gestures by healthcare professionals, known as Mangomoments, are translated into practice, what their preconditions are and what their impact is on patients and families, healthcare professionals and organisations. Design A multi-method design was used based on four phases: (1) A (media)campaign to collect Mangomoment stories (n=1045), of which 94% (n=983) were defined as Mangomoments; (2) Semi-structured interviews (n=120); (3) Focus group interviews (n=3); and (4) A consensus meeting. Setting Respondents from a hospital and primary care setting. Participants Patients, family, healthcare professionals, managers, researchers and a policymaker participated. Results Mangomoments are mainly classified in the dimensions a \u20ac Respect for values, preferences and needs' and a 'Emotional support'. Differences in importance of the dimensions were found between healthcare professionals, oncological patients and family and non-oncological patients and family. The results of the interviews, focus groups and consensus meeting were visualised by the Mangomoment model. It identifies several preconditions on the level of patients, healthcare professionals and leadership. For each of these preconditions a catalyst was identified to increase the prevalence of Mangomoments. In general, Mangomoments improved the patient and family experience and facilitated adherence to therapy and led to a positive perception on the healing process. Positive effects for professionals include personal accomplishment and anti-burnout, joy in work and a positive team atmosphere. This led to positive resonance by a relationship of trust between the patient and the healthcare professionals, feelings of tolerance during negative experiences and open communication and a safe climate. Overall, patients and healthcare workers concluded that Mangomoments led to loyalty to the healthcare organisation. Conclusion Mangomoments do not only have a positive impact on patient and family but also on the healthcare professional. Leadership should shape several preconditions and catalysts which can lead to positive resonance and loyalty of patients and professionals

Response of AGATA Segmented HPGe Detectors to Gamma Rays up to 15.1 MeV

The response of AGATA segmented HPGe detectors to gamma rays in the energy range 2-15 MeV was measured. The 15.1 MeV gamma rays were produced using the reaction d(11B,ng)12C at Ebeam = 19.1 MeV, while gamma-rays between 2 to 9 MeV were produced using an Am-Be-Fe radioactive source. The energy resolution and linearity were studied and the energy-to-pulse-height conversion resulted to be linear within 0.05%. Experimental interaction multiplicity distributions are discussed and compared with the results of Geant4 simulations. It is shown that the application of gamma-ray tracking allows a suppression of background radiation following neutron capture by Ge nuclei. Finally the Doppler correction for the 15.1 MeV gamma line, performed using the position information extracted with Pulse-shape Analysis, is discussed.Comment: 10 pages, 11 figure

Older adult experience of care and staffing on hospital and community wards: a cross-sectional study

BACKGROUND: Recent major concerns about the quality of healthcare delivered to older adults have been linked to inadequate staffing and a lack of patient-centred care. Patient experience is a key component of quality care - yet there has been little research on whether and how staffing levels and staffing types affect satisfaction amongst older adult hospital inpatients. This study aimed to evaluate the association between registered nurse and healthcare assistant staffing levels and satisfaction with care amongst older adult hospital inpatients, and to test whether any positive effect of higher staffing levels is mediated by staff feeling they have more time to care for patients. METHODS: Survey data from 4928 inpatients aged 65 years and older and 2237 medical and nursing staff from 123 acute and community medical wards in England, United Kingdom (UK) was collected through the Royal College of Psychiatrist's Elder Care Quality Mark. The cross-sectional association between staffing ratios and older adult patient satisfaction, and mediation by staff perceived time to care, was evaluated using multi-level modelling, adjusted for ward type and with a random effect for ward identity. RESULTS: Higher numbers of patients per healthcare assistant were associated with poorer patient satisfaction (adjusted β = - 0.32, 95% CI - 0.55 to 0.10, p < 0.01), and this was found to be partially mediated by all ward staff reporting less time to care for patients (adjusted β = - 0.10, bias-corrected 95% CI - 1.16 to - 0.02). By contrast, in both unadjusted and adjusted models, the number of patients per registered nurse was not associated with patient satisfaction. CONCLUSIONS: Older adult hospital patients may particularly value the type of care provided by healthcare assistants, such as basic personal care and supportive communication. Additionally, higher availability of healthcare assistants may contribute to all ward staff feeling more able to spend time with patients. However, high availability of registered nurses has been shown in other research to be vital for ensuring quality and safety of patient care. Future research should seek to identify the ideal balance of registered nurses and healthcare assistants for optimising a range of outcomes amongst older adult patients

Deathscapes of Settler Colonialism : The necro-settlement of Stoney Creek, Ontario, Canada

This is the Accepted Manuscript of an article published by Taylor & Francis Group in annals of Association of American Geographers on 23 January 2018, available online https://doi.org/10.1080/24694452.2017.1406327. The Accepted Manuscript is under embargo until 23 January 2019.This article considers the influence of burials and memorials to colonial soldiers from an earlier era on contemporary social and cultural landscapes in Canada. Through the example of a landscape centered on Smith’s Knoll, a burial ground for war dead from the British-American War of 1812, it explores the process of necro-settlement: the strengthening of settler colonial claims to land based on the development of complex, meaningladen landscapes of dead and memory. This article consists of three parts: The first situates geographical studies of deathscapes alongside theories about settler colonialism through intersecting discourses of land use. The second includes a settler colonial microhistorical geography of Smith’s Knoll and the local deathscape that surrounds it. The third section draws on this case study to reveal new perspectives on the role of burial and memorial in settler colonial place-making and the erasure of Indigenous histories and peoples.Peer reviewedFinal Accepted Versio

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

Contains fulltext : 97171.pdf (postprint version ) (Open Access)BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe

Identification of high-spin proton configurations in Ba 136 and Ba 137

19 pags., 11 figs., 3 tabs.The high-spin structures of Ba136 and Ba137 are investigated after multinucleon-transfer (MNT) and fusion-evaporation reactions. Ba136 is populated in a Xe136+U238 MNT reaction employing the high-resolution Advanced GAmma Tracking Array (AGATA) coupled to the magnetic spectrometer PRISMA at the Laboratori Nazionali di Legnaro, Italy, and in two Be9+Te130 fusion-evaporation reactions using the High-efficiency Observatory for γ-Ray Unique Spectroscopy (HORUS) at the FN tandem accelerator of the University of Cologne, Germany. Furthermore, both isotopes are populated in an elusive reaction channel in the B11+Te130 fusion-evaporation reaction utilizing the HORUS γ-ray array. The level scheme above the Jπ=10+ isomer in Ba136 is revised and extended up to an excitation energy of approximately 5.5 MeV. From the results of angular-correlation measurements, the Ex=3707- and Ex=4920-keV states are identified as the bandheads of positive- and negative-parity cascades. While the high-spin regimes of both Te132 and Xe134 are characterized by high-energy 12+→10+ transitions, the Ba136E2 ground-state band is interrupted by negative-parity states only a few hundred keV above the Jπ=10+ isomer. Furthermore, spins are established for several hitherto unassigned high-spin states in Ba137. The new results close a gap along the high-spin structure of N<82 Ba isotopes. Experimental results are compared to large-scale shell-model calculations employing the GCN50:82, Realistic SM, PQM130, and SN100PN interactions. The calculations suggest that the bandheads of the positive-parity bands in both isotopes are predominantly of proton character.Furthermore, we express our thanks to Dr. E. Teruya and Dr. N. Yoshinaga from Saitama University, Japan, for providing the results of their shellmodel calculation with the PQM130 interaction. The research leading to these results has received funding from the German BMBF under Contracts No. 05P15PKFN9 TP1 and No. 05P18PKFN9 TP1, from the European Union Seventh Framework Programme FP7/2007-2013 under Grant Agreement No. 262010 - ENSAR, from the Spanish Ministerio de Ciencia e Innovación under Contract No. FPA2011-29854- C04, from the Spanish Ministerio de Economía y Competitividad under Contract No. FPA2014-57196-C5, and from the UK Science and Technology Facilities Council (STFC). L.K. and A.V. thank the Bonn-Cologne Graduate School of Physics and Astronomy (BCGS) for financial support. One of the authors (A. Gadea) has been supported by the Generalitat Valenciana, Spain, under Grant No. PROMETEOII/2014/019, and EU under the FEDER program

Computed Tomography Measurement of Rib Cage Morphometry in Emphysema

Background: Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. Methods: Rib cage diameters and areas (calculated from the inner surface of the rib cage) in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT). CTs were analyzed with software, which allows quantification of total emphysema (emphysema%). The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. Results: A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1)%, and forced vital capacity (FVC)% fit best with the rib cage measurements (R2  = 64% for the rib cage area variation at the lower anatomical level). Gender had the biggest impact on rib cage diameter and area (105.3 cm2; 95% CI: 111.7 to 98.8 for male lower area). Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm2; 95% CI: 3.0 to 7.8 for an emphysema increase of 5%). Lower rib cage areas decreased as FVC% decreased (5.1 cm2; 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation). Conclusions: This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema