Performance gap among nurses in splint application and crutch training

Abstract The aim of this CNL internship project is to improve the current nursing practices by closing the performance gap among nurses on splint applications and crutch training within the 3-month course of this project. This project was implemented in a urgent care setting where Minor injuries such as sprains, strains or fractures are commonly seen by immobilization by application of splints which is given by the nursing staff. Micro assessment of the work flow of unit showed that only a few members of the staff routinely do these procedures and results from a self- assessment survey showed that 50% of the staff need assistance when they are task to complete these orders. These factors revealed that a primary cause of this disparity is a gap in knowledge and skill. The data complied supports that this gap can be addressed through the implementation educational training sessions. The format of training sessions was composed of a pre -intervention assessment, training/teaching, hands on practice by learner . The learners were later re-assessed during the post interventional assessment to evaluate their level of improvement which was measured by the competency checklist used throughout the training session to measure the individual learner’s baseline knowledge and skill as well as tool guide during the teaching portion of the training sessions. The materials used as a reference to confirm standards of care are the organization’s policy and procedures of splint applications and crutch training for patients, the organization’s education training manual of orthopedic procedures and crutch training, written after-care splint instructions for patients used in the unit, manufacture instructions sheets of splint materials, picture posters and signage sheets posted on each room of the unit as visual aids. Practice materials for hands on training are same splint materials and crutches used in the unit. Of the 15 nurses available to participate, seven nurses were willing to take part in the training sessions. Pre-interventional assessment of these seven nurses revealed varying degrees of knowledge and competency. Post -interventional assessment of these seven nurses revealed that improved their skill and knowledge on each of the objectives in the checklist, however they all they not yet gained enough mastery to independently practice them on patients. The results of post training self -assessment survey given to the seven nurses showed that they all believed that their competency has improved, had more interest and felt more confident in doing these procedures. They all responded that they felt that continuation of their training by partnering up with a mentor is effective method in improving their practice, which was recommended as the next phase of this project. The nurse manager gave support of continuing the next phase of this project on an informal basis. However, I believe due to the support of the staff the next phase will be realized

The Prognostic Significance of the Preoperative Full Blood Count after Resection of Colorectal Liver Metastases

Introduction. Increased preoperative platelet and neutrophil counts are risk factors for decreased survival in several different malignancies. Our aim was to investigate the relationship between overall or disease-free survival after resection of CRLM and the preoperative haematological parameters. Methods. We reviewed a cohort of 140 patients who underwent resection of CRLM with curative intent, utilising prospectively maintained databases. Patient demographics, operative details, FBC, CRP, INR, histopathology results, and survival data were examined. Kaplan-Meier survival and Cox regression analyses were used to determine the impact of all variables on survival. Results. 140 patients (96 males) with a median age of 67 years (range 33–82 years) underwent resection of CRLM. A significant correlation was exhibited between preoperative platelet count and neutrophil count (rho = 0.186, P = .028). When modelled as continuous covariates in a Cox regression hazards, an increased preoperative platelet (P = .02) and neutrophil counts (P ≤ .001) were significantly associated with overall survival. Of the haematological parameters assessed only preoperative platelet count showed a strong trend of association with disease free survival; however this failed to reach statistical significance (P = .076). Conclusions. Increased preoperative platelet and neutrophil counts are independent risk factors for decreased survival in patients undergoing resection of CRLM in our series of patients. These findings require validation in larger studies to determine their relationship with survival. Further research into the role of these cell types in tumour progression, particularly in the development and inhibition of angiogenesis, is warranted

Parallel Evaluation of Multi-join Queries

A number of execution strategies for parallel evaluation of multi-join queries have been proposed in the literature. In this paper we give a comparative performance evaluation of four execution strategies by implementing all of them on the same parallel database system, PRISMA/DB. Experiments have been done up to 80 processors. These strategies, coming from the literature, are named: Sequential Parallel, Synchronous Execution, Segmented Right-Deep, and Full Parallel. Based on the experiments clear guidelines are given when to use which strategy. This is an extended abstract; the full paper appeared in Proc. ACM SIGMOD'94, Minneapolis, Minnesota, May 24–27, 199

Comparación de frecuencias alélicas y genotípicas de los polimorfismos CAPN1-316 Y CAPN1-4751 del gen de la Calpaina en tres poblaciones de ganado criollo boliviano

La terneza de la carne está en parte determinada por el sistema proteico calpaína (CAPN1) / calpastatina (CAST). Bolivia posee en los llanos tres biotipos de ganado Criollo: los Yacumeños, los Chaqueños y los Saavedreños. El objetivo del presente trabajo fue determinar la frecuencia alélica y genotípica del gen de la CAPN1 en tres poblaciones de ganado Criollo de Bolivia. Se obtuvieron muestras de sangre de 28 Criollos del Chaco (CCH), 85 Criollos Yacumeños (CYA) y 30 Criollos Saavedreños (CSV). El ADN se extrajo utilizando el kit comercial Wizard® Genomic Purification, y posteriormente se tipificaron dos polimorfismos (CAPN1-316 y CAPN1-4751) del gen CAPN1 mediante el método ARMS-PCR. La frecuencias alélicas y genotípicas, las heterocigosidades esperadas y observadas, así como, el índice FIS y el desequilibrio de ligamiento (LD) fueron calculadas mediante los programas MS-Tools y Genepop. Las frecuencias de los alelos asociados a mayor terneza para las poblaciones de CCH, CYA y CSV fueron: 23%, 22% y 33 % para el alelo C del SNP CAPN1-316 y 75%, 76% y 60% para el alelo C del CAPN1-4751. La heterocigocidad observada en las tres poblaciones se hallan en un rango de 0,30 a 0,46 para el marcador CAPN1-316 y de 0,21 a 0,60 para el polimorfismo CAPN1-4751. Los resultados demuestran que los bovinos criollos en las poblaciones analizadas poseen altas frecuencias alélicas para las variantes asociadas a mayor terneza de la carne. Por otra parte, no se observaron valores significativos de LD (P>0,01) entre los dos polimorfismos tipificados en las poblaciones estudiadas. Sería necesario tipificar ambos polimorfismos en futuros programas de selección asistida por marcadores genéticos.Meat tenderness is in part determined by the calpain (CAPN1) / calpastatin (CAST) genes. In the lowlands of Bolivia, three well differentiated Creole cattle populations can be distinguished: the Yacumeños, Chaqueños and Saavedreños. The main objective of this research was to determine the allelic and genotypic frequencies of two polymorphisms of the calpain gene in three Creole cattle populations in Bolivia. Blood samples of 28 Creole cattle from Chaqueño cattle (CCH), 85 from Yacumeño cattle (CYA) and 30 from Saavadreño cattle (CSV) were collected. Total DNA was extracted using the commercial kit Wizard® Genomic Purification and subsequently two polymorphisms (CAPN1-316 and CAPN1- 4751) of the CAPN1 gene were genotyped by the amplification refractory mutation system (ARMS-PCR) method. Allelic and genotypic frequencies, expected and observed heterozygosities, the FIS index and the magnitude of linkage disequilibrium (LD) were calculated using the software MS-Tools and Genepop. The allelic frequencies of variants associated with tenderness in the three populations CCH, CYA and CSV were 23%, 22% and 23% for the CAPN1- 316 and 75%, 76% and 60% for the CAPN1-4751. The observed heterozygosities in the three populations fluctuated between 0.30 and 0.46 for the CAPN1-316 marker and between 0.21 and 0.60 for the CAPN1-4751 marker. The results showed that the analysed populations of Creole cattle presented high frequencies of the alleles previously associated with tenderness in meat. The analysis of LD, however, did not show evidence of linkage between the two markers. It is necessary to perform a genetic analysis for both polymorphisms if included in future selection programs.Fil: Pereira, J. A. C.. Universidad Autónoma Gabriel René Moreno; BoliviaFil: Falomir Lockhart, Agustin Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Loza, A.. Universidad Autónoma Gabriel René Moreno; BoliviaFil: Villegas Castagnasso, Egle Etel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Rojas, P.. Universidad Autónoma Gabriel René Moreno; BoliviaFil: Carino, M. . Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Ripoli, María Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; ArgentinaFil: Giovambattista, Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico La Plata. Instituto de Genética Veterinaria "Ingeniero Fernando Noel Dulout"; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Veterinarias; Argentin

"A few good men": Public sector audit in the Swan River Colony, 1828-1835

The appointment of the Auditor General to undertake public sector audit is the primary instrument used to safeguard public finances in most contemporary Westminster-based democracies. It is axiomatic that the independence of the Auditor General from executive government is a critical element in ensuring the effectiveness of the role, yet this separation is a relatively recent phenomenon. Those responsible for nineteenth century public sector audit in the Australian colonies operated in what would today be considered an unacceptable environment, with little, if any, independence from the executive arm of government. Yet, while several other Australian colonies suffered from the mismanagement of government finances, there is nothing to show that the Swan River Colony experienced much more than clerical errors and minor administrative oversights. In this article, we explore the extent to which satisfactory public financial management in the Swan River Colony occurred as a result of both good financial management systems (in the context of the era) and the appointment of competent and ethical administrators – “a few good men”

Quasi-phase-matched up- and down-conversion in periodically poled layered semiconductors

Nonlinear optics lies at the heart of classical and quantum light generation. The invention of periodic poling revolutionized nonlinear optics and its commercial applications by enabling robust quasi-phase-matching in crystals such as lithium niobate. However, reaching useful frequency conversion efficiencies requires macroscopic dimensions, limiting further technology development and integration. Here we realize a periodically poled van der Waals semiconductor (3R-MoS$_2$). Due to its exceptional nonlinearity, we achieve macroscopic frequency conversion efficiency over a microscopic thickness of only 1.2${\mu}$m, $10-100\times$ thinner than current systems with similar performances. Due to unique intrinsic cavity effects, the thickness-dependent quasi-phase-matched second harmonic signal surpasses the usual quadratic enhancement by $50\%$. Further, we report the broadband generation of photon pairs at telecom wavelengths via quasi-phase-matched spontaneous parametric down-conversion. This work opens the new and unexplored field of phase-matched nonlinear optics with microscopic van der Waals crystals, unlocking applications that require simple, ultra-compact technologies such as on-chip entangled photon-pair sources for integrated quantum circuitry and sensing

Risk factors for incident prostate cancer in a cohort of world trade center responders

Despite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence

Broadband stimulated Raman imaging based on multi-channel lock-in detection for spectral histopathology

Spontaneous Raman microscopy reveals the chemical composition of a sample in a label-free and non-invasive fashion by directly measuring the vibrational spectra of molecules. However, its extremely low cross section prevents its application to fast imaging. Stimulated Raman scattering (SRS) amplifies the signal by several orders of magnitude thanks to the coherent nature of the nonlinear process, thus unlocking high-speed microscopy applications that provide analytical information to elucidate biochemical mechanisms with subcellular resolution. Nevertheless, in its standard implementation, narrowband SRS provides images at only one frequency at a time, which is not sufficient to distinguish constituents with overlapping Raman bands. Here, we report a broadband SRS microscope equipped with a home-built multichannel lock-in amplifier simultaneously measuring the SRS signal at 32 frequencies with integration time down to 44 μs, allowing for detailed, high spatial resolution mapping of spectrally congested samples. We demonstrate the capability of our microscope to differentiate the chemical constituents of heterogeneous samples by measuring the relative concentrations of different fatty acids in cultured hepatocytes at the single lipid droplet level and by differentiating tumor from peritumoral tissue in a preclinical mouse model of fibrosarcoma

Comparison of allelic and genotypic frequencies of the polymorphisms CAPN1-316 and CAPN1-47151 of the calpain gene among three bolivian criollo cattle populations

La terneza de la carne está en parte determinada por el sistema proteico calpaína (CAPN1) / calpastatina (CAST). Bolivia posee en los llanos tres biotipos de ganado Criollo: los Yacumeños, los Chaqueños y los Saavedreños. El objetivo del presente trabajo fue determinar la frecuencia alélica y genotípica del gen de la CAPN1 en tres poblaciones de ganado Criollo de Bolivia. Se obtuvieron muestras de sangre de 28 Criollos del Chaco (CCH), 85 Criollos Yacumeños (CYA) y 30 Criollos Saavedreños (CSV). El ADN se extrajo utilizando el kit comercial Wizard® Genomic Purification, y posteriormente se tipificaron dos polimorfismos (CAPN1-316 y CAPN1-4751) del gen CAPN1 mediante el método ARMS-PCR. La frecuencias alélicas y genotípicas, las heterocigosidades esperadas y observadas, así como, el índice FIS y el desequilibrio de ligamiento (LD) fueron calculadas mediante los programas MS-Tools y Genepop. Las frecuencias de los alelos asociados a mayor terneza para las poblaciones de CCH, CYA y CSV fueron: 23%, 22% y 33 % para el alelo C del SNP CAPN1-316 y 75%, 76% y 60% para el alelo C del CAPN1-4751. La heterocigocidad observada en las tres poblaciones se hallan en un rango de 0,30 a 0,46 para el marcador CAPN1-316 y de 0,21 a 0,60 para el polimorfismo CAPN1-4751. Los resultados demuestran que los bovinos criollos en las poblaciones analizadas poseen altas frecuencias alélicas para las variantes asociadas a mayor terneza de la carne. Por otra parte, no se observaron valores significativos de LD (P>0,01) entre los dos polimorfismos tipificados en las poblaciones estudiadas. Sería necesario tipificar ambos polimorfismos en futuros programas de selección asistida por marcadores genéticos.Meat tenderness is in part determined by the calpain (CAPN1) / calpastatin (CAST) genes. In the lowlands of Bolivia, three well differentiated Creole cattle populations can be distinguished: the Yacumeños, Chaqueños and Saavedreños. The main objective of this research was to determine the allelic and genotypic frequencies of two polymorphisms of the calpain gene in three Creole cattle populations in Bolivia. Blood samples of 28 Creole cattle from Chaqueño cattle (CCH), 85 from Yacumeño cattle (CYA) and 30 from Saavadreño cattle (CSV) were collected. Total DNA was extracted using the commercial kit Wizard® Genomic Purification and subsequently two polymorphisms (CAPN1-316 and CAPN1- 4751) of the CAPN1 gene were genotyped by the amplification refractory mutation system (ARMS-PCR) method. Allelic and genotypic frequencies, expected and observed heterozygosities, the FIS index and the magnitude of linkage disequilibrium (LD) were calculated using the software MS-Tools and Genepop. The allelic frequencies of variants associated with tenderness in the three populations CCH, CYA and CSV were 23%, 22% and 23% for the CAPN1- 316 and 75%, 76% and 60% for the CAPN1-4751. The observed heterozygosities in the three populations fluctuated between 0.30 and 0.46 for the CAPN1-316 marker and between 0.21 and 0.60 for the CAPN1-4751 marker. The results showed that the analysed populations of Creole cattle presented high frequencies of the alleles previously associated with tenderness in meat. The analysis of LD, however, did not show evidence of linkage between the two markers. It is necessary to perform a genetic analysis for both polymorphisms if included in future selection programs.Instituto de Genética Veterinari

One health surveillance for rabies : a case study of integrated bite case management in Albay Province, Philippines

Canine rabies is a significant public health concern and economic burden in the Philippines. Animal Bite Treatment Centers (ABTCs) that provide post-exposure prophylaxis (PEP) to bite patients have been established across the country, but the incidence of bite patient presentations has grown unsustainably, whilst rabies transmission in domestic dogs has not been controlled. Moreover, weak surveillance leads to low case detection and late outbreak responses. Here we investigated the potential for Integrated Bite Case Management (IBCM) to improve rabies detection in Albay province. Using information obtained from animal bite histories combined with phone follow-ups and field investigations, we demonstrated that IBCM resulted in a fourfold increase in case detection over 13 months of study compared to the prior period. Bite patient incidence across Albay was very high (>600/100,000 persons/year) with PEP administered mostly indiscriminately. Clinic attendance reflected availability of PEP and proximity to ABTCs rather than rabies incidence (<3% of patient presentations were from “probable” or confirmed rabies exposures) and is therefore not a suitable indicator of rabies burden. Further analysis of the IBCM data suggests that rabies transmission is mostly localized with focal cases from the previous month and current cases in neighbouring villages being most predictive of future rabies occurrence. We conclude that investigations of suspicious biting incidents identified through IBCM have potential to foster intersectoral relationships, and collaborative investments between public health and veterinary services, enabling the One Health ethos to be applied in a more sustainable and equitable way. Triage of patients and investigations of suspect dogs offer an effective tool for improved PEP provisioning and reduction of unnecessary expenditure, whilst targeted field investigations should lead to increased and earlier detection of rabid dogs. Given the enduring risk of re-introductions from neighbouring populations, enhanced surveillance is critical to achieving and maintaining rabies freedom