Readiness for improving safe care delivery through web-based hospital nurse scheduling & staffing technology: A multi-hospital approach

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare worker fatigue on patient outcomes (IOM, 2004; Stimpfel & Aiken, 2013). The impending nursing shortage has the potential to exacerbate the problem of high quality care delivery and could lead to devastating impacts to the profession as well as patients. Though Kaiser Permanente (KP) is generally known for being a healthcare trailblazer, staffing technology was lagging. The purpose of this project is to prepare KP nursing for transformative change with web-based hospital scheduling and staffing. This work addresses the readiness for deployment across the KP system. Complexity and change theories frame this project. Hospital staffing epitomizes complexity. This planned change provides a road map for other nurse leaders to navigate the lessons learned. Satisfaction surveys from 222 nursing staff receiving training in the new technology reveal a favorable intent for technology adoption. Future work will focus on the impact realization of nurse-sensitive outcome indicators and registered nurse overtime

Computer vision in microstructural analysis

The following is a laboratory experiment designed to be performed by advanced-high school and beginning-college students. It is hoped that this experiment will create an interest in and further understanding of materials science. The objective of this experiment is to demonstrate that the microstructure of engineered materials is affected by the processing conditions in manufacture, and that it is possible to characterize the microstructure using image analysis with a computer. The principle of computer vision will first be introduced followed by the description of the system developed at Texas A&M University. This in turn will be followed by the description of the experiment to obtain differences in microstructure and the characterization of the microstructure using computer vision

Blastic Plasmacytoid Dendritic Cell Neoplasm with Extensive Cutaneous and Central Nervous System Involvement

Blastic plasmacytoid dendritic neoplasm is an exceedingly rare tumor that has undergone several changes in nomenclature over the last two decades, largely because of confusion regarding its cell of origin. It does, however, have distinctive clinical features with a particularly aggressive clinical course and no standard treatment. Overall, prognosis is poor and relapse is routine after initial response to chemotherapy. In this report, we describe a typical patient with this disease and reconcile the available literature and its evolution. We emphasize the leukemic nature of this tumor\u27s behavior, with extensive central nervous system and skin involvement, and describe for the first time a potential role for maintenance chemotherapy in its treatment

Constructing a criterion-referenced test in psychometric subjects according to item response theory

The article aimed to construct criterion-referenced in the psychometric subject based on item response theory. The sample consisted of (121) participants (54 male & 67 female) selected from the Department of Psychology at Isra University (Jordan) during the second semester of the academic year 2021/2022. The criterion-referenced test consisted of (36) items following a multiple-choice shape in which each item has 4 options. The results showed the assumptions of items response theory in the study data and matched the responses to (34) items. The results found that there were two items that did not match the model of item response theory that were deleted. Finally, the results of the parameter assessments of the items (discrimination, difficulty, and estimation) indicated that they were agreeable with the test criteria mentioned in psychometric literature and educational. In light of the results obtained, the study recommended using the test, which was developed by the researchers to assess student’s achievement in the subject of psychometrics for students of Psychology, because it demonstrates acceptable validity and reliability and complies with the requirements of the logarithmic three-parameter model, and the possibility of using the same methods as assessments for other courses after ensuring their psychometric qualities

Metastatic Angiosarcoma and Kasabach-Merritt Syndrome

Angiosarcomas are exceedingly rare tumors that are often difficult to diagnose. Exceptionally unusual is the presentation of these tumors with Kasabach-Merritt Syndrome, a curious form of intratumoral coagulation that can be impossible to distinguish from intravascular coagulation, which is more common. Instant recognition of this clinical association can help making a prompt diagnosis and timely initiation of therapy

Sequential drain amylase to guide drain removal following pancreatectomy

BACKGROUND: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. METHODS: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. RESULTS: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. CONCLUSIONS: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful

Medium-scale gravity wave activity in the thermosphere inferred from GOCE data

This study is focused on the effect of solar flux conditions on the dynamics of gravity waves (GWs) in the thermosphere. Air density and crosswind in situ estimates from the Gravity Field and Steady-State Ocean Circulation Explorer (GOCE) accelerometers are analyzed for the whole mission duration. The analysis is performed in the Fourier spectral domain averaging spectral results over periods of 2 months close to solstices. A new GW marker (called C3f) is introduced here to characterize GWs activity under low, medium, and high solar flux conditions, showing a clear solar damping effect on GW activity. Most GW signal is found in a spectral range above 8 mHz in GOCE data, meaning a maximum horizontal wavelength of around 1000 km. The level of GW activity at GOCE altitude is strongly decreasing with increasing solar flux. Furthermore, a shift in the dominant frequency with solar flux conditions has been noted, leading to larger horizontal wavelengths (from 200 to 500 km) during high solar flux conditions. The correlation between air density variability and GW marker allows to identify most of the large-amplitude perturbations below 67∘ latitudes as due to GWs. The influence of correlated error sources, between air density and crosswinds, is discussed. Consistency of the spectral domain results is verified in the time domain with a global mapping of high-frequency air density perturbations along the GOCE orbit. This analysis shows a clear dependence with geomagnetic latitude with strong perturbations at magnetic poles and an extension to lower latitudes favored by low solar activity conditions. These results are consistent with previous Challenging Minisatellite Payload (CHAMP) data analysis and with general circulation models

Bacterial lipid II analogs : novel in vitro substrates for mammalian oligosaccharyl diphosphodolichol diphosphatase (DLODP) activities

Mammalian protein N-glycosylation requires the transfer of an oligosaccharide containing 2 residues of N-acetylglucosamine, 9 residues of mannose and 3 residues of glucose (Glc3Man9 GlcNAc2) from Glc3Man9GlcNAc2-diphospho (PP)-dolichol (DLO) onto proteins in the endoplasmic reticulum (ER). Under some pathophysiological conditions, DLO biosynthesis is perturbed, and truncated DLO is hydrolyzed to yield oligosaccharyl phosphates (OSP) via unidentified mechanisms. DLO diphosphatase activity (DLODP) was described in vitro, but its characterization is hampered by a lack of convenient non-radioactive substrates. Our objective was to develop a fluorescence-based assay for DLO hydrolysis. Using a vancomycin-based solid-phase extraction procedure coupled with thin layer chromatography (TLC) and mass spectrometry, we demonstrate that mouse liver membrane extracts hydrolyze fluorescent bacterial lipid II (LII: GlcNAc-MurNAc(dansyl-pentapeptide)-PP-undecaprenol) to yield GlcNAc-MurNAc(dansyl-pentapeptide)-P (GM5P). GM5P production by solubilized liver microsomal proteins shows similar biochemical characteristics to those reported for human hepatocellular carcinoma HepG2 cell DLODP activity. To conclude, we show, for the first time, hydrolysis of lipid II by a eukaryotic enzyme. As LII and DLO are hydrolyzed by the same, or closely related, enzymes, fluorescent lipid II analogs are convenient non-radioactive substrates for investigating DLODP and DLODP-like activities

Treatment of Human Epidermal Growth Factor Receptor 2-Overexpressing Breast Cancer Xenografts With Multiagent HER-Targeted Therapy

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