Differences in work environment for staff as an explanation for variation in central line bundle compliance in intensive care units.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. FINDINGS: Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. PRACTICE IMPLICATIONS: Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality

Risk prediction to inform surveillance of chronic kidney disease in the US Healthcare Safety Net: a cohort study.

BackgroundThe capacity of electronic health record (EHR) data to guide targeted surveillance in chronic kidney disease (CKD) is unclear. We sought to leverage EHR data for predicting risk of progressing from CKD to end-stage renal disease (ESRD) to help inform surveillance of CKD among vulnerable patients from the healthcare safety-net.MethodsWe conducted a retrospective cohort study of adults (n = 28,779) with CKD who received care within 2 regional safety-net health systems during 1996-2009 in the Western United States. The primary outcomes were progression to ESRD and death as ascertained by linkage with United States Renal Data System and Social Security Administration Death Master files, respectively, through September 29, 2011. We evaluated the performance of 3 models which included demographic, comorbidity and laboratory data to predict progression of CKD to ESRD in conditions commonly targeted for disease management (hypertension, diabetes, chronic viral diseases and severe CKD) using traditional discriminatory criteria (AUC) and recent criteria intended to guide population health management strategies.ResultsOverall, 1730 persons progressed to end-stage renal disease and 7628 died during median follow-up of 6.6 years. Performance of risk models incorporating common EHR variables was highest in hypertension, intermediate in diabetes and chronic viral diseases, and lowest in severe CKD. Surveillance of persons who were in the highest quintile of ESRD risk yielded 83-94 %, 74-95 %, and 75-82 % of cases who progressed to ESRD among patients with hypertension, diabetes and chronic viral diseases, respectively. Similar surveillance yielded 42-71 % of ESRD cases among those with severe CKD. Discrimination in all conditions was universally high (AUC ≥0.80) when evaluated using traditional criteria.ConclusionsRecently proposed discriminatory criteria account for varying risk distribution and when applied to common clinical conditions may help to inform surveillance of CKD in diverse populations

Social participation in the information society : Poland compared to the European Union countries

PURPOSE: The purpose of the considerations undertaken in the article is to analyze the level of citizen participation in the information society in Poland in the context of the formation of this phenomenon in EU countries, and to identify areas requiring intervention by state or local government bodies.DESIGN/METHODOLOGY/APPROACH: The following research methods were used in the article to achieve the stated purpose of the work: critical analysis of the literature on the subject, the method of cause-effect analysis, the method of comparative analysis and the method of case analysis.FINDINGS: The analysis carried out indicates that the basic indicators characterizing the participation of citizens in the information society in Poland significantly deviate from the level presented by EU member states. This dissonance is particularly evident in the case of people who do not use the Internet and do not have basic digital skills. This state of affairs makes these people unable to actively participate in the information society. This problem may be a significant barrier to the further development of the information society in Poland and requires the intervention of government and local administration.PRACTICAL IMPLICATIONS: The results of the research can provide important information for state and local government bodies and educational institutions in the development of the information society.ORIGINALITY/VALUE: The research conducted in the article points to an important issue in the formation of widespread participation of citizens in the information society in Poland and contributes to the solution of this problem.The project is financed within the framework of the program of the Minister of Science and Higher Education under the name "Regional Excellence Initiative" in the years 2019 - 2022; project number 001/RID/2018/19; the amount of financing PLN 10,684,000.00.peer-reviewe

Problemy konkurencyjności rynku usług telekomunikacyjnych w Polsce

The level of competitiveness of the telecommunications market in Poland is the major factor determining this marketSJability to achieve rapid and long-term growth, which should be translated into economic, qualitative and cost effective aspects of telecommunication services. Obviously, the competitiveness of the market is the result of the competitiveness of enterprises operating on the market. The article presents the competitiveness of particular segments of the telecommunications market as well as the telecommunications operators operating on it

Strategie rozwoju zewnętrznego w praktyce funkcjonowania rynku komunikacji elektronicznej w Polsce

In conditions of strong competition on the market of electronic communication services, market saturation in telecommunication services and the necessity of bearing significant investment outlays on infrastructure expansion, operators are forced to do strategic activities aiming on the improve-ment of their market and competitive position. One of the acceptable strategic solution in this market situation is the option of external development. In the article there are presented: the existing and potential alliances, telecommunication operators takeovers and caused market shifts

Information society : Poland in comparison with the European Union

PURPOSE: The purpose of this paper is to analyse the level of development of the information society in Poland in the context of the development of this phenomenon in EU countries and to identify areas requiring intervention by state and local government bodies.DESIGN/METHODOLOGY/APPROACH: The following research methods were used to achieve the stated aim of the paper: critical analysis of the literature on the subject, causal analysis method, comparative analysis method and case study method.CONCLUSIONS: The analysis conducted shows that the basic indicators characterising the information society in Poland do not differ from the level of the EU countries. The problem that will determine further development is the existence of a relatively large percentage of people who do not use the Internet and do not have basic digital skills. This state of affairs makes it impossible for these people to fulfil their social and economic functions and thus to participate actively in the information society.PRACTICAL IMPLICATIONS: The results of the study can provide important information for state and local authorities and the regulator of the electronic communications market in Poland, shaping activities in the development of the information society.ORIGINALITY/VALUE: The research conducted in this article contributes to the discussion on the formation of the information society in Poland and the directions of its further development.The project is financed within the framework of the program of the Minister of Science and Higher Education under the name "Regional Excellence Initiative" in the years 2019 - 2022; project number 001/RID/2018/19; the amount of financing PLN 10,684,000.00.peer-reviewe

Advanced digital skills in the information society : Poland compared to the European Union

PURPOSE: The purpose of the considerations undertaken in the article is to analyze the level of advanced digital skills in Poland in the context of the formation of this phenomenon in EU countries, and to identify measures aimed at increasing the number of citizens with advanced digital skills.DESIGN/METHODOLOGY/APPROACH: The article uses the following research methods to achieve the stated purpose of the work: critical analysis of the literature on the subject, causal analysis method, comparative analysis method and case study method.FINDINGS: The conducted analysis indicates that the indicators characterizing the advanced digital skills of citizens in Poland significantly deviate from the level presented by EU member states. This dissonance may have very serious consequences for the emergence and dissemination of technological and social innovations, technological progress and competitiveness. This problem may constitute a significant barrier to the further development of the information society in Poland and requires intervention by the government and local administration.PRACTICAL IMPLICATIONS: The results of the study may provide important information for state and local government administration bodies and educational institutions in the development of skills relevant to the formation of the information society.ORIGINALITY/VALUE: The research conducted in the article indicates an important issue in the formation of advanced digital skills of citizens in the information society in Poland and contributes to the solution of this problem.Subsidy for research activities in the discipline of socio-economic geography and spatial management, no. 503-0003-230000-01.peer-reviewe

Complete Mapping of Divergent Amino Acids Responsible for Differential Ligand Binding of Folate Receptors α and β

The folate receptor (FR) type alpha may be distinguished from FR-beta by its higher affinity for the circulating folate coenzyme, (6S)-5-methyltetrahydrofolate (5-CH3H4folate), and its opposite stereospecificity for reduced folate coenzymes. Previous studies showed that a single leucine to alanine substitution at position 49 of the mature protein sequence is responsible for the functional divergence of FR-beta (Shen, F., Zheng, X., Wang, H., and Ratnam, M. (1997) Biochemistry 36, 6157-6163); however, the results also indicated that the minimum requirement for conversion of FR-beta to the functional equivalent of FR-alpha should include amino acid substitution(s) downstream of residue 92 in addition to mutation of L49A. To pinpoint those residues, chimeric FR-betaL49A/FR-alpha constructs including progressively shorter segments of FR-alpha downstream of position 92 as well as selected point mutants were studied. Simultaneous substitution of Leu-49, Phe-104, and Gly-166 in FR-beta with the corresponding FR-alpha residues Ala, Val, and Glu, respectively, reconstituted the ligand binding characteristics of FR-alpha. The results also exclude a role for other residues in FR-alpha in determining its functional divergence. A homology model of FR-alpha based on the three-dimensional structure of the chicken riboflavin-binding protein is used to show the position of residues 49, 104, and 166 in relation to the hydrophobic cleft corresponding to the riboflavin-binding pocket

The influence of selected factors on the strenght of wood adhesive joints

This paper examines the effect of selected factors on the wood bonded joint strength. The structural factor under scrutiny was the geometry of the surface area; however, other major dimensions of adherends were compared as well. The tests were per-formed on 6 joint types: butt, v-shaped, interlocking, scarf, tongue & groove, and single lap joints, which were formed on two types of substrate materials – pine and oak wood, and adhesively bonded. The joints were bonded with Prefere 6312 wood adhesive and Loctite 3430 two-component epoxy adhesive. Strength testing of the joints was performed on Zwick/Roell Z150 material testing machine, according to DIN EN 1465 standard. The results obtained from the tests indicate that bonded joints of oak wood exhibit higher strength properties than those of pine wood adherends, which was confirmed in nearly all strength tests

Occupation of wood warbler Phylloscopus sibilatrix nests by Myrmica and Lasius ants

Bird nests can provide habitats for various invertebrates, including ectoparasites, scavengers and predators. Records of ants associating with active bird nests mostly involve the insects searching for food, with some exceptional records of ants raising their broods (eggs, larvae or pupae) within songbird nests in tree cavities. We present data for a previously undocumented, but apparently regular, occurrence of ants and their broods within the active nests of a songbird, the wood warbler Phylloscopus sibilatrix (Bechstein, 1793), which builds domed nests on the ground in European forests. Systematic recording found ants, mostly Myrmica ruginodis Nylander, 1846, in 43% of 80 wood warbler nests in the primary forest of Białowieża National Park (Poland) during the springs of 2016-2017, including ant broods in 30%. Ad hoc records from this site in 2004-2015 found ants in a further 29% of 163 nests, including broods in 20%, indicating a regular association. However, examination of 37 nests from secondary forest in Switzerland and Great Britain founds ants in only 14%, and broods in just 5%. We discuss the potential drivers and mechanisms of the observed association between breeding wood warblers and ants, including the apparent difference in frequency between the primary and secondary forests