The Impact of Simulation Sequencing on Perceived Clinical Decision Making

An emerging nursing education trend is to utilize simulated learning experiences as a means to optimize competency and decision making skills. The purpose of this study was to examine differences in students\u27 perception of clinical decision making and clinical decision making-related self-confidence and anxiety based on the sequence (order) in which they participated in a block of simulated versus hospital-based learning experiences. A quasi-experimental crossover design was used. Between and within group differences were found relative to self-confidence with the decision making process. When comparing groups, at baseline the simulation followed by hospital group had significantly higher self-confidence scores, however, at 14-weeks both groups were not significantly different. Significant within group differences were found in the simulation followed by hospital group only, demonstrating a significant decrease in clinical decision making related anxiety across the semester. Finally, there were no significant difference in; perceived clinical decision making within or between the groups at the two measurement points. Preliminary findings suggest that simulated learning experiences can be offered with alternating sequences without impacting the process, anxiety or confidence with clinical decision making. This study provides beginning evidence to guide curriculum development and allow flexibility based on student needs and available resources

Mapping Fashion in the \u27City by the Sea\u27: Shopping Districts in Newport, Rhode Island

Newport, Rhode Island is internationally recognized for both its prime location on Narragansett Bay and its storied history. Nicknamed the ‘City by the Sea,’ it is famous for its world-class sailing, colonial New England architecture, Gilded Age mansions, trendy restaurants and bars, and nearby beaches. Cultural tourism is a multi-million dollar business for Rhode Island, especially for Newport, where shopping is fourth on the list of revenue generators. The relationship of an American resort city’s geographical setting, built environment, and cultural heritage to its fashion retail sector has not been explored. Acknowledging that fashion contributes to a city’s image, the authors review Newport’s history, provide a profile of Newport today, map Newport’s nine shopping districts, and analyze Newport’s fashion retail sector on the various streets, squares, wharves, and piers. Such an analysis may prove useful to retailers in other resort cities—both small independent boutique owners and national chain stores—as well as city planners and tourism boards

Uncovering precision phenotype-biomarker associations in traumatic brain injury using topological data analysis

Background: Traumatic brain injury (TBI) is a complex disorder that is traditionally stratified based on clinical signs and symptoms. Recent imaging and molecular biomarker innovations provide unprecedented opportunities for improved TBI precision medicine, incorporating patho-anatomical and molecular mechanisms. Complete integration of these diverse data for TBI diagnosis and patient stratification remains an unmet challenge. Methods and findings: The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot multicenter study enrolled 586 acute TBI patients and collected diverse common data elements (TBI-CDEs) across the study population, including imaging, genetics, and clinical outcomes. We then applied topology-based data-driven discovery to identify natural subgroups of patients, based on the TBI-CDEs collected. Our hypothesis was two-fold: 1) A machine learning tool known as topological data analysis (TDA) would reveal data-driven patterns in patient outcomes to identify candidate biomarkers of recovery, and 2) TDA-identified biomarkers would significantly predict patient outcome recovery after TBI using more traditional methods of univariate statistical tests. TDA algorithms organized and mapped the data of TBI patients in multidimensional space, identifying a subset of mild TBI patients with a specific multivariate phenotype associated with unfavorable outcome at 3 and 6 months after injury. Further analyses revealed that this patient subset had high rates of post-traumatic stress disorder (PTSD), and enrichment in several distinct genetic polymorphisms associated with cellular responses to stress and DNA damage (PARP1), and in striatal dopamine processing (ANKK1, COMT, DRD2). Conclusions: TDA identified a unique diagnostic subgroup of patients with unfavorable outcome after mild TBI that were significantly predicted by the presence of specific genetic polymorphisms. Machine learning methods such as TDA may provide a robust method for patient stratification and treatment planning targeting identified biomarkers in future clinical trials in TBI patients

Aplastic anemia associated with interferon alpha 2a in a patient with chronic hepatitis C virus infection: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hepatitis-associated aplastic anemia is a common syndrome in patients with bone marrow failure. However, hepatitis-associated aplastic anemia is an immune-mediated disease that does not appear to be caused by any of the known hepatitis viruses including hepatitis C virus. In addition, to the best of our knowledge there are no reported cases of patients with chronic hepatitis C virus infection developing aplastic anemia associated with pegylated interferon alpha 2a treatment.</p> <p>Case presentation</p> <p>We report the case of a 46-year-old Greek man who developed severe aplastic anemia during treatment with pegylated interferon alpha 2a for chronic hepatitis C virus infection. He presented with generalized purpura and bruising, as well as pallor of the skin and mucous membranes. His blood tests showed pancytopenia. He underwent allogeneic bone marrow transplantation after completing two courses of immunosuppressive therapy with antithymocyte globulin and cyclosporin A.</p> <p>Conclusions</p> <p>The combination of a specific environmental precipitant represented by the hepatitis C virus infection, an altered metabolic detoxification pathway due to treatment with pegylated interferon alpha 2a and a facilitating genetic background such as polymorphism in metabolic detoxification pathways and specific human leukocyte antigen genes possibly conspired synergistically in the development of aplastic anemia in this patient. Our case clearly shows that the causative role of pegylated interferon alpha 2a in the development of aplastic anemia must not be ignored.</p

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Information Assurance, Intelligence and Security: Opportunities and Directions for Future Research

A growing number of the iSchools have recently begun to emphasize programs of research directed towards the topic of information assurance, intelligence and security. Covering such areas as network and infrastructure security, information systems auditing and security practices and standards, behavioral security studies, information and technology risk management, and business continuity planning, the idea of information security has become a focus of not only iSchools but major corporations and intelligence agencies. This field is also receiving much attention in practitioner and academic institutions, and increasingly universities are developing new courses, minors, programs, and research centers in an attempt to expand the field. This roundtable would present a picture of the current state of research in the information assurance and security field including current trends, directions and new areas of emphasis for future research, how the iSchools have the potential to develop unique contributions to the field, and possible collaborations between iSchool researchers and other departments. Hosted by a combination of tenure-track professors and PhD candidates with research and/or professional experience in the information assurance, intelligence and security field, this roundtable would introduce attendees to significant research opportunities and the role of iSchools in this growing field

Environment of language: an examination of the work of James Britton in the light of the Alberta high school English curriculum

Bibliography: p. 100-101

Standar perawatan pasien: Proses keperawatan, diagnosis dan evaluasi Vol. 1

xvi, 222 hlm.; 27 c

Patient care Standards: Nursing process, diagnosis, and outcome

xvii, 920 hlm.; ilus.; 28 c

PAN-00017228 - block weight of lead cast with relief

This find is registered at Portable Antiquities of the Netherlands with number PAN-0001722