Prospectus Summary Brief: NICU Communication Improvement

Joy Lawley RNC, NICU Communication Improvement: A prospectus summary brief. Effective communication in the neonatal intensive care unit (NICU) not only reduces errors and adverse patient outcomes but also create an environment that promotes staff satisfaction. The purpose of this prospectus is that of improving the process of communication between the perinatal departments. The specific aim was to improve communication to the NICU through standardize communication tools (SBAR) from patient delivery to discharge starting April 1, 2015. With 100% participation of all staff members within a three month period and a 95% staff satisfaction related to improved communication from staff survey and reduction of missing information from chart audits by June 1, 2015. A form of structured standardized communication Situation, Background, Assessment, and Recommendation (SBAR) was used to develop communications tools for admission and delivery nurse handoff report. The SBAR tools were integrated into the NICU and maternal child department of a 366 bed non-profit acute care hospital with a 22 bed community level III NICU. Lewin’s change theory was the framework. Evaluation methods yielded both quantitative and qualitative results through chart audits, direct observation and staff survey

Reconsidering "the love of art" : evaluating the potential of art museum outreach

Art museums have long been identified as bastions of social and cultural exclusion. This conclusion was best evidenced by the large-scale 1967 French study by Bourdieu and Darbel demonstrating the exclusionary nature of “The Love of Art.” However, in recent years there have been increasing efforts to reach out to a broader range of visitors beyond conventional audiences. The present study investigates the impacts of an outreach program at a UK art museum, which sought to engage socially excluded young mothers. This study employs ethnographic research methods on a longitudinal basis to develop qualitative insights about the program seeking to mitigate cultural exclusion. While the study’s findings uphold many longstanding critiques of art museums’ conventional approaches, the study also indicates that carefully designed outreach activities can overcome such limitations and enhance cultural engagement. Thus, art museums’ limited appeal is tied to problematic public engagement practices that can be changed

The Role of Habit, Childhood Consumption, Familiarity and Attitudes Across Seafood Consumption Segments in Australia

Australian consumers hold very favorable attitudes toward seafood, with key drivers to consumption being taste, convenience, diet variety, and health benefits. Nevertheless, despite these positive attitudes, seafood consumption remains below many other countries. In this article, we investigate the influence of habit including regular childhood consumption, familiarity with seafood, and attitudes toward seafood on seafood consumption and consumption occasions. Habit and lack of familiarity with seafood were found to lead to lower levels of seafood consumption, whereas positive attitudes toward seafood were associated with more regular seafood consumption. People who consumed seafood on a regular basis as a child were more likely to be more familiar with seafood and be in the habit of consuming seafood in adulthood. Patterns of childhood consumption occasions were found to be associated with adult consumption occasions. Based on these findings, we discuss possible strategies and behavioral interventions for further investigation, which are grounded in habit theory and are aimed at changing seafood eating habits, increasing childhood consumption, and reducing the lack of familiarity with seafood

Triangulating data sources for further learning from and about the MDSR in Ethiopia: a cross-sectional review of facilitybased maternal death data from EmONCassessment and MDSR system

Background Triangulating findings from MDSR with other sources can better inform maternal health programs. A national Emergency Obstetric and Newborn Care (EmONC) assessment and the Maternal Death Surveillance and Response (MDSR) system provided data to determine the coverage of MDSR implementation in health facilities, the leading causes and contributing factors to death, and the extent to which life-saving interventions were provided to deceased women. Methods This paper is based on triangulation of findings from a descriptive analysis of secondary data extracted from the 2016 EmONC assessment and the MDSR system databases. EmONC assessment was conducted in 3804 health facilities. Data from interview of each facility leader on MDSR implementation, review of 1305 registered maternal deaths and 679 chart reviews of maternal deaths that happened form May 16, 2015 to December 15, 2016 were included from the EmONC assessment. Case summary reports of 601 reviewed maternal deaths were included from the MDSR system. Results A maternal death review committee was established in 64% of health facilities. 5.5% of facilities had submitted at least one maternal death summary report to the national MDSR database. Postpartum hemorrhage (10–27%) and severe preeclampsia/eclampsia (10–24.1%) were the leading primary causes of maternal death. In MDSR, delay-1 factors contributed to 7–33% of maternal deaths. Delay-2, related to reaching a facility, contributed to 32% & 40% of maternal deaths in the EmONC assessment and MDSR, respectively. Similarly, delay-3 factor due to delayed transfer of mothers to appropriate level of care contributed for 29 and 22% of maternal deaths. From the EmONC data, 72% of the women who died due to severe pre-eclampsia or eclampsia were given anticonvulsants while 48% of those dying of postpartum haemorrhage received uterotonics. Conclusion The facility level implementation coverage of MDSR was sub-optimal. Obstetric hemorrhage and severe preeclampsia or eclampsia were the leading causes of maternal death. Delayed arrival to facility (Delay 2) was the predominant contributing factor to facility-based maternal deaths. The limited EmONC provision should be the focus of quality improvement in health facilities.publishedVersio

The determinants of long-run economic growth: A conceptually and computationally simple approach

Durlauf, Johnson, and Temple (2005) forcefully argue that the empirical analysis of economic growth is one of the areas of economics in which progress seems to be hardest to achieve and where only few definite results are established. Large sets of potentially relevant candidate variables have been used in empirical analysis to capture what Brock and Durlauf (2001) refer to as theory open endedness of economic growth. A large variety of different approaches has been and is used to identify variables relevant for economic growth. Many of the contributions employ model averaging estimators to tackle the uncertainty about the relevant variables. Sala-i-Martin (1997a) runs two million regressions and uses a modification of the extreme bounds test of Leamer (1985), used in the growth context earlier also by Levine and Renelt (1992), to single out what he calls ‘significant’ variables. Fernandez, Ley, and Steel (2001) and Sala-i-Martin, Doppelhofer, and Miller (2004) use Bayesian model averaging (BMA) techniques to identify important growth determinants. The former perform Bayesian averaging of Bayesian estimates, introduced by Leamer (1978), whereas the latter perform Bayesian averaging of classical estimates, proposed by Raftery (1995)

Adhesion of tumour-infiltrating lymphocytes to endothelium: a phenotypic and functional analysis.

Efficacy of cancer immunotherapy with cultured tumour-infiltrating lymphocytes (TILs) depends upon infused TILs migrating into tumour-bearing tissue, in which they mediate an anti-tumour response. For TILs to enter a tumour, they must first bind to tumour endothelium, and this process depends on TILs expressing and regulating the function of relevant cell-surface receptors. We analysed the cell-surface phenotype and endothelial binding of TILs cultured from human melanoma and compared them with peripheral blood T cells and with allostimulated T cells cultured under similar conditions. Compared with peripheral blood T cells, TILs expressed high levels of five integrins, two other adhesion molecules, including the skin homing molecule CLA, and several activation markers and showed markedly enhanced integrin-mediated adhesion to a dermal microvascular endothelial cell line in vitro. Compared with the allostimulated T cells, TILs expressed higher levels of the cutaneous lymphocyte antigen (CLA), the adhesion molecule CD31 and the activation markers CD30 and CD69, but lower levels of several other adhesion and activation molecules. These phenotypic and functional properties of TILs should have complex effects on their migration in vivo. Expression of CLA, the skin homing receptor, may increase migration to melanoma (a skin cancer), whereas integrin activation may cause non-specific binding of TILs to other endothelium. Manipulation of the culture conditions in which TILs are expanded might result in a phenotype that is more conducive to selective tumour homing in vivo

Application of asymptotic expansions of maximum likelihood estimators errors to gravitational waves from binary mergers: the single interferometer case

In this paper we describe a new methodology to calculate analytically the error for a maximum likelihood estimate (MLE) for physical parameters from Gravitational wave signals. All the existing litterature focuses on the usage of the Cramer Rao Lower bounds (CRLB) as a mean to approximate the errors for large signal to noise ratios. We show here how the variance and the bias of a MLE estimate can be expressed instead in inverse powers of the signal to noise ratios where the first order in the variance expansion is the CRLB. As an application we compute the second order of the variance and bias for MLE of physical parameters from the inspiral phase of binary mergers and for noises of gravitational wave interferometers . We also compare the improved error estimate with existing numerical estimates. The value of the second order of the variance expansions allows to get error predictions closer to what is observed in numerical simulations. It also predicts correctly the necessary SNR to approximate the error with the CRLB and provides new insight on the relationship between waveform properties SNR and estimation errors. For example the timing match filtering becomes optimal only if the SNR is larger than the kurtosis of the gravitational wave spectrum

Diffusive transport in the presence of stochastically gated absorption

We analyze a population of Brownian particles moving in a spatially uniform environment with stochastically gated absorption. The state of the environment at time t is represented by a discrete stochastic variable k ( t ) ∈ { 0 , 1 } such that the rate of absorption is γ [ 1 − k ( t ) ] , with γ a positive constant. The variable k ( t ) evolves according to a two-state Markov chain. We focus on how stochastic gating affects the attenuation of particle absorption with distance from a localized source in a one-dimensional domain. In the static case (no gating), the steady-state attenuation is given by an exponential with length constant √ D / γ , where D is the diffusivity. We show that gating leads to slower, nonexponential attenuation. We also explore statistical correlations between particles due to the fact that they all diffuse in the same switching environment. Such correlations can be determined in terms of moments of the solution to a corresponding stochastic Fokker-Planck equation