Development and Implementation of an Ambulatory Nursing Shared Governance Council

The purpose of this work was to research, develop, and implement an ambulatory nursing shared governance council (ANSGC) to support the pursuit of Magnet designation within the Primary Care and Specialty Institute (PCASI) ambulatory care nursing environment at Rochester Regional Health. PCASI is comprised of over 115 practices located throughout 8 counties. Literature supports shared governance as a mechanism to increase nurse engagement, nurse retention, improve patient outcomes and promotes partnership between front line nurses and administration. Nursing Shared Governance is a pillar of the American Nurses Credentialing Center (ANCC) Magnet culture and a critical component of Magnet designation. PCASI nursing leaders, also serving as ANSGC advisors, developed the foundation to support meaningful execution and development of an effective structure, ensuring adequate representation of all PCASI nurses. The ANSGC advisors supported and empowered PCASI nurses throughout the implementation process. Essential to success was evaluation of the perceived baseline management style within PCASI and nurse understanding of shared governance. The ANSGC advisors identified the Index of Professional Nursing Governance (IPNG) survey, an evidence based tool, to establish baseline understanding of PCASI nurse perceptions around professional governance. Initial survey results indicated the presence of a traditional management style. Implementation of an ANSGC has launched a structure for shared governance in the ambulatory setting. The ability to measure and benchmark nurse perceptions surrounding shared governance in the ambulatory environment provided PCASI with meaningful information to help drive improvements across and positioned the organization to achieve initial Magnet designation in July 2022.https://scholar.rochesterregional.org/nursingresearchday/1014/thumbnail.jp

Valosin-containing protein regulates the proteasome-mediated degradation of DNA-PKcs in glioma cells.

DNA-dependent protein kinase (DNA-PK) has an important role in the repair of DNA damage and regulates the radiation sensitivity of glioblastoma cells. The VCP (valosine-containing protein), a chaperone protein that regulates ubiquitin-dependent protein degradation, is phosphorylated by DNA-PK and recruited to DNA double-strand break sites to regulate DNA damage repair. However, it is not clear whether VCP is involved in DNA-PKcs (DNA-PK catalytic subunit) degradation or whether it regulates the radiosensitivity of glioblastoma. Our data demonstrated that DNA-PKcs was ubiquitinated and bound to VCP. VCP knockdown resulted in the accumulation of the DNA-PKcs protein in glioblastoma cells, and the proteasome inhibitor MG132 synergised this increase. As expected, this increase promoted the efficiency of DNA repair in several glioblastoma cell lines; in turn, this enhanced activity decreased the radiation sensitivity and prolonged the survival fraction of glioblastoma cells in vitro. Moreover, the VCP knockdown in glioblastoma cells reduced the survival time of the xenografted mice with radiation treatment relative to the control xenografted glioblastoma mice. In addition, the VCP protein was also downregulated in ~25% of GBM tissues from patients (WHO, grade IV astrocytoma), and the VCP protein level was correlated with patient survival (R(2)=0.5222, P<0.05). These findings demonstrated that VCP regulates DNA-PKcs degradation and increases the sensitivity of GBM cells to radiation

On the dependence of the critical success index (CSI) on prevalence

The critical success index (CSI) is an established metric used in meteorology to verify the accuracy of weather forecasts. It is defined as the ratio of hits to the sum of hits, false alarms, and misses. Translationally, CSI has gained popularity as a unitary outcome measure in various clinical situations where large numbers of true negatives may influence the interpretation of other, more traditional, outcome measures, such as specificity (Spec) and negative predictive value (NPV), or when unified interpretation of positive predictive value (PPV) and sensitivity (Sens) is needed. The derivation of CSI from measures including PPV has prompted questions as to whether and how CSI values may vary with disease prevalence (P), just as PPV estimates are dependent on P, and hence whether CSI values are generalizable between studies with differing prevalences. As no detailed study of the relation of CSI to prevalence has been undertaken hitherto, the dataset of a previously published test accuracy study of a cognitive screening instrument was interrogated to address this question. Three different methods were used to examine the change in CSI across a range of prevalences, using both the Bayes formula and equations directly relating CSI to Sens, PPV, P, and the test threshold (Q). These approaches showed that, as expected, CSI does vary with prevalence, but the dependence differs according to the method of calculation that is adopted. Bayesian rescaling of both Sens and PPV generates a concave curve, suggesting that CSI will be maximal at a particular prevalence, which may vary according to the particular dataset

Critical success index or F measure to validate the accuracy of administrative healthcare data identifying epilepsy in deceased adults in Scotland

Background: Methods to undertake diagnostic accuracy studies of administrative epilepsy data are challenged bylack of a way to reliably rank case-ascertainment algorithms in order of their accuracy. This is because it isdifficult to know how to prioritise positive predictive value (PPV) and sensitivity (Sens). Large numbers of truenegative (TN) instances frequently found in epilepsy studies make it difficult to discriminate algorithm accuracyon the basis of negative predictive value (NPV) and specificity (Spec) as these become inflated (usually >90%).This study demonstrates the complementary value of using weather forecasting or machine learning metricscritical success index (CSI) or F measure, respectively, as unitary metrics combining PPV and sensitivity. Wereanalyse data published in a diagnostic accuracy study of administrative epilepsy mortality data in Scotland.Method: CSI was calculated as 1/[(1/PPV) + (1/Sens) – 1]. F measure was calculated as 2.PPV.Sens/(PPV +Sens). CSI and F values range from 0 to 1, interpreted as 0 = inaccurate prediction and 1 = perfect accuracy. Thepublished algorithms were reanalysed using these and their accuracy re-ranked according to CSI in order to allowcomparison to the original rankings.Results: CSI scores were conservative (range 0.02–0.826), always less than or equal to the lower of the correspondingPPV (range 39–100%) and sensitivity (range 2–93%). F values were less conservative (range0.039–0.905), sometimes higher than either PPV or sensitivity, but were always higher than CSI. Low CSI and Fvalues occurred when there was a large difference between PPV and sensitivity, e.g. CSI was 0.02 and F was0.039 in an instance when PPV was 100% and sensitivity was 2%. Algorithms with both high PPV and sensitivityperformed best in terms of CSI and F measure, e.g. CSI was 0.826 and F was 0.905 in an instance when PPV was90% and sensitivity was 91%.Conclusion: CSI or F measure can combine PPV and sensitivity values into a convenient single metric that is easierto interpret and rank in terms of diagnostic accuracy than trying to rank diagnostic accuracy according to the twomeasures themselves. CSI or F prioritise instances where both PPV and sensitivity are high over instances wherethere are large differences between PPV and sensitivity (even if one of these is very high), allowing diagnosticaccuracy thresholds based on combined PPV and sensitivity to be determined. Therefore, CSI or F measures maybe helpful complementary metrics to report alongside PPV and sensitivity in diagnostic accuracy studies ofadministrative epilepsy data

The open source guild: creating more sustainable enterprise?

© 2017, © Emerald Publishing Limited. Purpose: The purpose of this paper is to report on an action research project with two emergent micro-businesses that explored how their business model connected with the principles of open source. Design/methodology/approach: The authors first gained initial qualitative data to establish the core values of each micro-business, which the authors then explored in the context of open source and business models in two design workshops with each organisation. Findings: The authors developed the open source guild business model, which has the elements of: building a focal micro-business with resources secured through the guild, promoting learning and development through apprenticeship, promoting shared values through a commons of experience and capturing value by protecting key intellectual property. Research limitations/implications: This research was undertaken with two emergent micro-businesses in the North West of England. Further research will be needed to establish the wider applicability of the open source guild model. Practical implications: The open source guild model can be a mechanism for an emergent micro-business to create a community around their values and grow their business without conventional external investment of resources. Originality/value: This research contributes to the literature on business models based on open source and how these models can be sustainable in terms of the quadruple bottom line, which extends the triple bottom line to include personal values and meaning

Thinking beyond the hybrid:“actually-existing” cities “after neoliberalism” in Boyle <i>et al.</i>

In their article, ‘The spatialities of actually existing neoliberalism in Glasgow, 1977 to present’, Mark Boyle, Christopher McWilliams and Gareth Rice (2008) usefully problematise our current understanding of neoliberal urbanism. Our response is aimed at developing a sympathetic but critical approach to Boyle et al's understanding of neoliberal urbanism as illustrated by the Glasgow example. In particular, the counterposing by Boyle et al of a 'hybrid, mutant' model to a 'pure' model of neoliberalism for us misrepresents existing models of neoliberalism as a perfectly finished object rather than a roughly mottled process. That they do not identify any ‘pure’ model leads them to create a straw construct against which they can claim a more sophisticated, refined approach to the messiness of neoliberal urbanism. In contrast, we view neoliberalism as a contested and unstable response to accumulation crises at various scales of analysis

Opportunities for topical antimicrobial therapy: permeation of canine skin by fusidic acid

BACKGROUND: Staphylococcal infection of the canine epidermis and hair follicle is amongst the commonest reasons for antimicrobial prescribing in small animal veterinary practice. Topical therapy with fusidic acid (FA) is an attractive alternative to systemic therapy based on low minimum inhibitory concentrations (MICs, commonly <0.03 mg/l) documented in canine pathogenic staphylococci, including strains of MRSA and MRSP (methicillin-resistant Staphylococcus aureus and S. pseudintermedius). However, permeation of canine skin by FA has not been evaluated in detail. This study aimed to define the degree and extent of FA permeation in canine skin in vitro from two sites with different hair follicle density following application of a licensed ophthalmic formulation that shares the same vehicle as an FA-betamethasone combination product approved for dermal application in dogs. Topical FA application was modelled using skin held in Franz-type diffusion cells. Concentrations of FA in surface swabs, receptor fluid, and transverse skin sections of defined anatomical depth were determined using high-performance liquid chromatography and ultraviolet (HPLC-UV) analysis. RESULTS: The majority of FA was recovered by surface swabs after 24 h, as expected (mean ± SEM: 76.0 ± 17.0%). FA was detected within 424/470 (90%) groups of serial sections of transversely cryotomed skin containing follicular infundibula, but never in 48/48 (100%) groups of sections containing only deeper follicular structures, nor in receptor fluid, suggesting that FA does not permeate beyond the infundibulum. The FA concentration (mean ± SEM) in the most superficial 240 μm of skin was 2000 ± 815 μg/g. CONCLUSIONS: Topically applied FA can greatly exceed MICs for canine pathogenic staphylococci at the most common sites of infection. Topical FA therapy should now be evaluated using available formulations in vivo as an alternative to systemic therapy for canine superficial bacterial folliculitis.Peer reviewedFinal Published versio

Towards a synthesized critique of neoliberal biodiversity conservation

During the last three decades, the arena of biodiversity conservation has largely aligned itself with the globally dominant political ideology of neoliberalism and associated governmentalities. Schemes such as payments for ecological services are promoted to reach the multiple ‘wins’ so desired: improved biodiversity conservation, economic development, (international) cooperation and poverty alleviation, amongst others. While critical scholarship with respect to understanding the linkages between neoliberalism, capitalism and the environment has a long tradition, a synthesized critique of neoliberal conservation - the ideology (and related practices) that the salvation of nature requires capitalist expansion - remains lacking. This paper aims to provide such a critique. We commence with the assertion that there has been a conflation between ‘economics’ and neoliberal ideology in conservation thinking and implementation. As a result, we argue, it becomes easier to distinguish the main problems that neoliberal win-win models pose for biodiversity conservation. These are framed around three points: the stimulation of contradictions; appropriation and misrepresentation and the disciplining of dissent. Inspired by Bruno Latour’s recent ‘compositionist manifesto’, the conclusion outlines some ideas for moving beyond critique