More Change Than You Think: Tracking Oregon Farmers’ Markets and Their Managers 1998-2005

Marketing,

Delays in the stroke thrombolysis pathway--identifying areas for improvement.

Despite international consensus on the benefits of thrombolysis for ischaemic stroke (IS), it remains underused. Guidelines now recommend a door-to-needle time of 60 minutes. We reviewed the rate and timeliness of thrombolysis for IS at our hospital. 323 stroke patients presented between January 2011 and April 2012.Thirty patients (10.6% of IS) were thrombolysed, mean age was 68.5 years (42 to 88) and 19 patients (63%) were male. Thirty-six patients (12.7% of IS) were not thrombolysed despite arriving within the time-window and symptom resolution was the commonest reason (15 patients; 42%). Despite most thrombolysed patients (42%) presenting to the Emergency Department during daytime working hours, there were delays at each step of the acute care pathway. The mean time for stroke team review was 23 minutes (5-50). The mean door-to-CT and the door-to-needle times were 60 minutes (25-95) and 92 minutes (46-130) respectively. In parallel with national stroke incentives, local audit can highlight barriers to uptake and efficiency within thrombolysis services

The Relationship Between Organizational Commmitment and Position in PostSecondary Education

Organizational commitment has been linked to important employee behaviors and perceptions, including turnover, intent to turnover, absenteeism, and job satisfaction. In spite of its important outcomes, the formation of commitment is not well documented and research concerning antecedents has provided inconsistent results. Little of this research has involved the postsecondary education field and characteristics unique to it. This study investigated the relationship between employee position and organizational commitment in the postsecondary education setting. The model of organizational commitment utilized was the three-component concept developed by Meyer and Allen (1997) composed of affective, continuance, and normative commitment. Research participants were 2,914 university employees. Using an online survey, participants responded to personal and position-related items and the organizational commitment assessment. The personal variables included were gender, age, and education level. The position-related variables were position as faculty, staff, or administration; full or part-time employment; tenure status; salaried or hourly pay status; years of employment at the university; retirement plan participation; and campus location. The survey also included a free-response item that asked participants why they responded as they did to the commitment items. As demonstrated by analysis of variance, position had a significant influence on affective, continuance, and normative commitment. For each commitment component, staff had significantly higher commitment than faculty. A difference was also found between staff and administration for continuance commitment. Hierarchical regression analysis for the personal and position variables yielded significant results for each of the commitment components as well. The block of position variables demonstrated a significant relationship with affective and normative commitment. The blocks of position and personal variables were significantly related to continuance commitment. The study findings concerning the lower organizational commitment of faculty, combined with the body of research demonstrating the outcomes associated with organizational commitment, should indicate to institutional leaders the need to be aware of and focus on organizational commitment as an important employee attitude

Profile of cardiovascular risk factors at six months post ischaemic stroke in Dublin: the ASPIRE-S study

Stroke is a leading cause o f death and disability in all countries and results in substantial personal and healthcare costs. Approximately one third of strokes occur in individuals with a previous transient ischaemic attack and one half occur in individuals with previous vascular events of any kind. The significant disease burden and the high recurrence rates of stroke emphasize the importance of both primary and secondary preventive strategies amongst all patients at high risk for stroke. In recent years numerous policies and guidelines on the secondary prevention o f stroke have been published and updated (nationally and internationally) that summarize important evidence based practice in stroke care which aim to improve cardiovascular disease and stroke outcomes, with resultant beneficial effects for healthcare systems and populations. However, few studies to date have assessed the adequacy o f secondary prevention after ischaemic stroke outside the trial setting. This study, Action on Secondary Prevention Interventions and Rehabilitation in Stroke (the ASPIRE-S study) aimed to prospectively assess the secondary prevention (and rehabilitation) profiles of over 300 patients six months following hospital admission for ischaemic stroke in Dublin across key dimensions of quality care, patient safety effective care and patient experience. This thesis focuses on the secondary prevention component o f ASPIRE-S. Results of this cross-sectional study revealed suboptimal control of many stroke risk factors. Office blood pressure was \u3c140/90 in 37% and \u3c130/80 in 16% of patients. On ambulatory blood pressure monitoring, more people had their blood pressure controlled by day than by night (66% versus 44%). Lipid control was suboptimal, with one quarter of patients failing to meet total cholesterol (\u3c4.5mmol/L) and LDL (\u3c2.5mmol/L) targets. In diabetic patients, 28% had HbAlc\u3e 7%. Many patients (68%) had an increased body mass index, were still smoking (16%) and were in the high (29%) or moderate risk (60%) category when the SCORE risk assessment tool was applied. Abnormal scores for anxiety (32%) and depression (22%) were detected in substantial proportions o f patients. Furthermore knowledge o f stroke risk factors and recall o f lifestyle advice received by patients were particularly poor at six months post stroke. The prescription o f secondary preventive medications (including anti-thrombotic (97%) and lipid-lowering (95%) medications) was, however, good in this cohort and self-reported medication adherence was excellent with a mean MARS score of 24.2/25. These results promote awareness of the importance of ongoing surveillance of cardiovascular risk after ischaemic stroke and support the need for re-evaluation of local secondary prevention programmes. Given the notable advances in the evidence base supporting the use o f secondary preventive therapies over the last two decades and the recent implementation of the national stroke clinical care programme in Ireland (resulting in substantially improved services for patients with stroke) it is imperative that programmes o f care secondary prevention (including assessment of risk factors and patient education) be optimised. Future initiatives should include the development of policies which support more effective, comprehensive, multidisciplinary patient education and risk factor management programmes for all patients with ischaemic stroke in Ireland

Maturity and stability evaluation of composted yard debris

Compost maturity is an important determinant of end use for composted municipal yard debris, and generally refers to the effect the compost has on plants. The rate of microbial respiration is an indicator of compost stability. The objectives of this research were to: i) determine whether continuous aeration resulted in more rapid maturity of composted yard debris than windrow turning; ii) determine which maturity indicators distinguish between mature and immature compost; iii) measure rates of CO₂ evolution during active composting and curing; iv) adapt the CO₂ detection tube technique for compost; and v) evaluate rapid compost stability tests (Solvita test, self-heating test and CO₂ detection tubes) for potential use by commercial composters. Land Recovery, Inc. of Puyallup, WA, composted yard debris under careful process control. Two compost piles were studied for 113 d; one was subjected to continuous forced aeration and periodic turning. The other was managed as a turned windrow. We found that forced aeration resulted in mature compost about 20 days before windrowing. Compost pH, C content and respiration rate were all useful indicators of compost maturity. Carbon fell from 400 k kg⁻¹ to 250 g kg⁻¹ and pH rose from 5 to 7. The CO₂ evolution rate fell from 16 to 2 mg CO₂-C g C⁻¹ d⁻¹. Maturity correlated somewhat with compost odor. Neither percent germination nor an odor/color scale were reliable indicators of maturity for theses composts. All the rapid tests were correlated with alkaline trapping of microbially respired CO₂. The Solvita test took 4 h to administer; values (1 to 8 Solvita scale) were 2 to 4 during active composting, 3 to 6 during early curing and 6 to 7 during late curing. Self-heating test values decreased from 20°C above ambient at the start of composting to ambient (no heat production) at the end of composting. This test took two to six days to administer. We developed a method to measure CO₂ evolution rates of samples in sealed containers using CO₂ detection tubes. This method took 4 h to administer, correlated well with alkaline trapping, was quantitative and had excellent sensitivity at extreme compost maturity. The methods shows promise as a raid test for compost respiration and should be evaluated on a wider range of composts

Newly Licensed RNs Describe What They Like Best about Being a Nurse

About 25% of newly licensed registered nurses (NLRNs) leave their first job within two years, but only 2% leave the nursing profession in this same timeframe. Therefore, the researchers sought to discover what new nurses like best about being a nurse, in hopes of gaining information that might help facilities to reduce turnover rates. Data were collected between January and March 2009 from 1,152 NLRNs licensed in 15 US states. Krippendorff's method was used to analyze survey responses. Five themes emerged: “providing holistic patient care,” “having an autonomous and collaborative practice,” “using diverse knowledge and skills to impact patient outcomes,” “receiving recognition,” and “having a job that is secure and stimulating.” Strategies are discussed that organizations might employ in helping NLRNs to realize what they best like about their work, which might lead to improved retention rates

Investigations into the effects of cyclical rhythm and hormonal contraception on serum fat-mobilizing activity, glycerol, cholesterol and blood glucose.

The effects were investigated of cyclical rhythm and hormonal contraception on serum fat-mobilizing activity, glycerol, cholesterol and whole blood glucose during 2 menstrual cycles in a group of normally menstruating young women and a second group of young women using hormonal contraception. A control group of normal young men was also investigated. There was no evidence of any change in mean level of any of the parameters measured, among the follicular, ovulatory and luteal phases. No cyclical pattern was discernable in the male subjects. The mean value for serum cholesterol concentration in women using hormonal contraception was higher than the value for the untreated human female group. The overall mean value for serum glycerol concentration in the women was significantly (0.01 > P > 0.001) higher than the mean value obtaining in the men

Clinically Competent Peers and Support for Education: Structures and Practices that Work

The preceding excerpts from interviews with staff nurses in magnet hospitals reflect the key messages reported in this article. (Unless otherwise stated, all excerpts are from staff nurses who were interviewed for this study. The professional role of the speaker is cited for physicians [MDs] and nurse managers [NMs].) Competency is multifaceted and evident through actions. Clinically competent peers is all about competent performance, not the potential for performance. Both performance and potential are important for quality patient care, but here we focus solely on what others see or hear that leads to the judgment or conclusion that nurses on the front line in acute care hospitals are clinically competent

Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study.

Background Cognitive impairment commonly occurs in the acute phase post-stroke, but may persist with over half of all stroke survivors experiencing some form of long-term cognitive deficit. Recent evidence suggests that optimising secondary prevention adherence is a critical factor in preventing recurrent stroke and the incidence of stroke-related cognitive impairment and dementia. The aim of this study was to profile cognitive impairment of stroke survivors at six months, and to identify factors associated with cognitive impairment post-stroke, focusing on indicators of adequate secondary prevention and psychological function. Methods Participants were assessed at six months following an ischaemic stroke as part of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke study (ASPIRE-S), which examined the secondary preventive and rehabilitative profile of patients in the community post-stroke. Cognitive impairment was measured using the Montreal Cognitive Assessment (MoCA). Results Two-hundred and fifty-six stroke patients were assessed at six months. Over half of the sample (56.6%) were found to have cognitive impairment, with significant associations between cognitive impairment and female sex (odds ratio (OR) = 1.6, 95% CI 1.01-2.57) and history of cerebrovascular disease (OR = 2.22, 95% CI 1.38-3.59). Treatment with antihypertensive medications (OR = .65, 95% CI .44-.96) and prescription of anticoagulant therapy (OR = .41, 95% CI .26-.68) were associated with reduced likelihood of cognitive impairment, however increasing number of total prescribed medications was moderately associated with poorer cognitive impairment (OR = 1.12, 95% CI 1.04-1.19). Conclusions Findings reveal levels of cognitive impairment at 6 months post-stroke that are concerning. Encouragingly, aspects of secondary prevention were identified that may be protective in reducing the incidence of cognitive impairment post-stroke. Neuropsychological rehabilitation post-stroke is also required as part of stroke rehabilitation models to meet the burden of post-stroke cognitive impairment