Evaluation of four gamma-based methods for calculating confidence intervals for age-adjusted mortality rates when data are sparse

Background Equal-tailed confidence intervals that maintain nominal coverage (0.95 or greater probability that a 95% confidence interval covers the true value) are useful in interval-based statistical reliability standards, because they remain conservative. For age-adjusted death rates, while the Fay–Feuer gamma method remains the gold standard, modifications have been proposed to streamline implementation and/or obtain more efficient intervals (shorter intervals that retain nominal coverage). Methods This paper evaluates three such modifications for use in interval-based statistical reliability standards, the Anderson–Rosenberg, Tiwari, and Fay–Kim intervals, when data are sparse and sample size-based standards alone are overly coarse. Initial simulations were anchored around small populations (P = 2400 or 1200), the median crude all-cause US mortality rate in 2010–2019 (833.8 per 100,000), and the corresponding age-specific probabilities of death. To allow for greater variation in the age-adjustment weights and age-specific probabilities, a second set of simulations draws those at random, while holding the mean number of deaths at 20 or 10. Finally, county-level mortality data by race/ethnicity from four causes are selected to capture even greater variation: all causes, external causes, congenital malformations, and Alzheimer disease. Results The three modifications had comparable performance when the number of deaths was large relative to the denominator and the age distribution was as in the standard population. However, for sparse county-level data by race/ethnicity for rarer causes of death, and for which the age distribution differed sharply from the standard population, coverage probability in all but the Fay–Feuer method sometimes fell below 0.95. More efficient intervals than the Fay–Feuer interval were identified under specific circumstances. When the coefficient of variation of the age-adjustment weights was below 0.5, the Anderson–Rosenberg and Tiwari intervals appeared to be more efficient, whereas when it was above 0.5, the Fay–Kim interval appeared to be more efficient. Conclusions As national and international agencies reassess prevailing data presentation standards to release age-adjusted estimates for smaller areas or population subgroups than previously presented, the Fay–Feuer interval can be used to develop interval-based statistical reliability standards with appropriate thresholds that are generally applicable. For data that meet certain statistical conditions, more efficient intervals could be considered

Less Talk; More Action: SBAR as an Interactive Approach for Ethical Decision- Making

Oftentimes as educators, instructors approach ethics education as if students have all the time in the world to pontificate. This article provides an alternative teaching strategy where there is less ‘talk’, and more action as the SBAR model is utilized in the ethical decision making process. A case study depicting a difficult patient care situation provides the backdrop for a discussion of ethical decision making as a skill which can be developed when sound reasoning and principles are applied by the nursing student or novice nurse. By assuring that students have a working understanding of the concept of advocacy from an ethical perspective, educators can promote nurses’ voices at the multidisciplinary table. Nurses need a practical, relevant approach or tool such as SBAR, which can be universally applied to various practice areas and patient care situations

Benefits of Implementing a Daily Safety Brief at the Baystate Children’s Hospital

Nursing Scholarship Symposium Event Posters.https://scholarlycommons.libraryinfo.bhs.org/nurs_presentations/1001/thumbnail.jp

The Relationship of Moral Distress, Ethical Environment and Nurse Job Satisfaction

Nurses are fundamental to the delivery of quality, safe and competent health care in multilevel complex systems. Faced with challenging, dynamic, and evolving patient care and workforce issues, nurses must create ethical environments, which foster a respectful climate in which decisions are made and supported. The current study examined the relationship between ethical climate, frequency of moral distress, intensity of moral distress, and overall job satisfaction among registered nurses at two hospitals located in the Southeastern United States as measured by the Moral Distress Scale and the Hospital Ethical Climate Survey. The results of the correlational study suggest a weak relationship between ethical climate and moral distress, but a moderate relationship exists between ethical climate and job satisfaction. Findings from this study highlight the importance of creating an ethical environment to improve job satisfaction which can ultimately result in improved patient care

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder and a major cause of disability in adults. Improvements following surgical decompression are limited and patients often remain severely disabled. Post mortem studies indicate that CSM is associated with profound axonal loss. However, our understanding of the pathophysiology of CSM remains limited.To investigate the hypothesis that axonal plasticity plays a role in the recovery following surgical decompression, we adopted a novel preclinical model of mild to moderate CSM. Spinal cord compression resulted in significant locomotor deterioration, increased expression of the axonal injury marker APP, and loss of serotonergic fibres. Surgical decompression partially reversed the deficits and attenuated APP expression. Decompression was also associated with axonal sprouting, reflected in the restoration of serotonergic fibres and an increase of GAP43 expression. The re-expression of synaptophysin indicated the restoration of functional synapses following decompression. Promoting axonal plasticity may therefore be a therapeutic strategy for promoting neurological recovery in CSM.Qatar Foundation, National Institute for Health Research (Clinician Scientist Award Grant ID: CS-2015-15-023), Royal Australasian College of Surgeons (Reg Worcester Research Fellowship), Neurosurgical Society of Australasia (Research Scholarship), Wellcome Trust, Medical Research CouncilThis is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s40478-016-0359-

Passive water control at the surface of a superhydrophobic lichen

Some lichens have a super-hydrophobic upper surface, which repels water drops, keeping the surface dry but probably preventing water uptake. Spore ejection requires water and is most efficient just after rainfall. This study was carried out to investigate how super-hydrophobic lichens manage water uptake and repellence at their fruiting bodies, or podetia. Drops of water were placed onto separate podetia of Cladonia chlorophaea and observed using optical microscopy and cryo-scanning-electron microscopy (cryo-SEM) techniques to determine the structure of podetia and to visualise their interaction with water droplets. SEM and optical microscopy studies revealed that the surface of the podetia was constructed in a three-level structural hierarchy. By cryo-SEM of water-glycerol droplets placed on the upper part of the podetium, pinning of the droplet to specific, hydrophilic spots (pycnidia/apothecia) was observed. The results suggest a mechanism for water uptake, which is highly sophisticated, using surface wettability to generate a passive response to different types of precipitation in a manner similar to the Namib Desert beetle. This mechanism is likely to be found in other organisms as it offers passive but selective water control