Job Embeddedness and Certified Nursing Assistant Retention in Skilled Nursing Facilities

Certified nursing assistants (CNA) are a critical part of the direct care provided in skilled nursing facilities (SNF). Turnover among CNAs results in patient care issues and increased costs to providers. Despite years of research into why CNAs leave their jobs, the turnover in this occupation continues to be the highest among direct caregivers in SNFs. Job Embeddedness (JE) is a construct that evaluates why people stay with their job. JE has been found to explain intent to leave and voluntary turnover over and above the traditional indicators of job satisfaction, organizational commitment, job alternatives, and job search. This quantitative, non-experimental correlational research study examined the relationship between JE and CNA retention. The analysis determined that there is a relationship between JE and CNA retention and was used to identify the elements of JE that are significant to CNA retention. The results may be beneficial to SNF leaders as they assess and modify their human resource management practices that are aimed at reducing turnover and increasing retention

Direct force-measuring transducer used in blood pressure research

Direct force measuring transducer acts as an arterial tonometer, gives a direct readout to instrumentation, and is unaffected by ambient noise. It uses a semiconductor strain gage which is deflected by pressure pulses in the artery. The deflection changes the resistance of the gage and alters the voltage reading on the associated instrumentation

Incidence of, predictors for, and mortality associated with malignant ventricular arrhythmias in non-ST elevation myocardial infarction patients.

BACKGROUND: The incidence of non-ST elevation myocardial infarction (NSTEMI) is increasing. Although life-threatening ventricular arrhythmias have been well-documented in patients with ST elevation MI (STEMI), their incidence and importance in NSTEMI have not been examined in similar detail. We examined the incidence, predictors, and mortality rates of ventricular arrhythmias in a cohort of NSTEMI patients undergoing an early invasive strategy. METHODS: Consecutive patients admitted with NSTEMI who underwent cardiac catheterization within 48 h of admission were identified by chart review. Presence and type of ventricular arrhythmias and 30-day mortality were recorded. Malignant arrhythmias were defined as sustained ventricular tachycardia (VT, \u3e100 beats/min lasting \u3e30 s) or fibrillation (VF). Clinical risk factors, laboratory values, findings on electrocardiogram, echocardiogram, cardiac catheterization, and revascularization procedure data were recorded. RESULTS: VT/VF occurred in 21 (7.6%) of 277 NSTEMI patients. Sixty percent of these events occurred within the first 48 h after hospital admission, with a median occurrence at 72 h. Twelve patients (4.3%) required defibrillation. Troponin levels were higher and left ventricular ejection fraction was lower in the VT/VF group. Multivariable analysis also identified the presence of left bundle branch block and need for urgent coronary artery bypass grafting as significant predictors of malignant ventricular arrhythmias. Thirty-day mortality was significantly higher in NSTEMI patients with malignant ventricular arrhythmias than without (38 vs. 3%, P\u3c0.001). CONCLUSION: Despite an early invasive strategy, malignant ventricular arrhythmias are frequent in NSTEMI patients and are associated with increased 30-day mortality

Elastic cavitation, tube hollowing, and differential growth in plants and biological tissues

Elastic cavitation is a well-known physical process by which elastic materials under stress can open cavities. Usually, cavitation is induced by applied loads on the elastic body. However, growing materials may generate stresses in the absence of applied loads and could induce cavity opening. Here, we demonstrate the possibility of spontaneous growth-induced cavitation in elastic materials and consider the implications of this phenomenon to biological tissues and in particular to the problem of schizogenous aerenchyma formation

Distribution of left ventricular ejection fraction in angina patients with severe coronary artery disease not amenable to revascularization.

BACKGROUND: As the number of angina patients with severe coronary artery disease not amenable to revascularization increases, new therapies will be developed. How patients with depressed compared to normal left ventricular ejection fraction (LVEF) will respond to new therapies may differ. HYPOTHESIS: We conducted a retrospective chart review to determine the distribution of LVEF in angina patients with severe coronary artery disease (three-vessel disease with \u3e50% stenosis major epicardial vessels or \u3e50% stenosis left main) not amenable to revascularization. METHODS: Patients underwent cardiac catheterization between 2004 and 2009. LVEF, measured by echocardiography, nuclear-gated imaging or radioventriculography within 6 months of catheterization, was recorded. Demographics, symptoms, risk factors, past myocardial infarction, catheterization results, medications, and the Duke Coronary Artery Jeopardy Score were recorded. RESULTS: Eight thousand six hundred and ninety-nine patient charts were reviewed; 124 met criteria. There was a continuous, and not bimodal, distribution of LVEF. Fifty-eight patients (47%) in the normal LVEF group were compared to 66 patients (53%) in the abnormal LVEF group ( CONCLUSION: There is a wide distribution of LVEF among angina patients not amenable to revascularization. A novel finding of this study showed that mortality was high regardless of LVEF. As new therapies for angina are developed, attention will need to be paid to how such therapies affect these two patient groups

Effect of obstructive sleep apnea on mitral valve tenting.

Obstructive apneas produce high negative intrathoracic pressure which imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no OSA (AHI \u3c 15) and mod/severe OSA (AHI ≥ 15). Mitral valve tenting height and area, left ventricular (LV) long and short axis, and LV end-diastolic volume (LVEDV), were measured along with tissue Doppler parameters. Comparisons of measurements at baseline and follow up between and within groups were obtained; correlations between absolute changes (deltas) in echocardiographic parameters were also performed. After a mean follow up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 cm to 1.28 ± 0.17 cm, p=0.001) in mod/severe OSA as did tenting area (2.30 ± 0.41 cm2 to 2.66 ± 0.60 cm2, p=0.0002); delta tenting height correlated with delta LVEDV (rho 0.43, p=0.01) and delta tenting area (rho 0.35, p=0.04). In mild/no OSA patients there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 cm2 to 2.31 ± 0.43 cm2, p=0.05). Septal E’ decreased (8.04 ± 2.49 cm/sec to 7.10 ± 1.83 cm/sec, p=0.005) in mod/severe OSA subjects, but not in the mild/no OSA group. In conclusion, in patients with mod/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry

Reaching the Unreachable: Barriers of the Poorest to Accessing NGO Healthcare Services in Bangladesh

The NGO Service Delivery Program (NSDP), a USAID-funded programme, is the largest NGO programme in Bangladesh. Its strategic flagship activity is the essential services package through which healthcare services are administered by NGOs in Bangladesh. The overall goal of the NSDP is to increase access to essential healthcare services by communities, especially the poor. Recognizing that the poorest in the community often have no access to essential healthcare services due to various barriers, a study was conducted to identify what the real barriers to access by the poor are. This included investigations to further understand the perceptions of the poor of real or imagined barriers to accessing healthcare; ways for healthcare centres to maximize services to the poor; how healthcare providers can maximize service-use; inter-personal communication between healthcare providers and those seeking healthcare among the poor; and ways to improve the capacity of service providers to reach the poorest segment of the community. The study, carried out in two phases, included 24 static and satellite clinics within the catchment areas of eight NGOs under the NSDP in Bangladesh, during June-September 2003. Participatory urban and rural appraisal techniques, focus-group discussions, and in-depth interviews were employed as research methods in the study. The target populations in the study included males and females, service-users and non-users, and special groups, such as fishermen, sex workers, potters, Bedes (river gypsies), and lower-caste people—all combined representing a heterogeneous community. The following four major categories of barriers emerged as roadblocks to accessing quality healthcare for the poor: (a) low income to be able to afford healthcare, (b) lack of awareness of the kind of healthcare services available, (c) deficiencies and inconsistencies in the quality of services, and (d) lack of close proximity to the healthcare facility. Those interviewed perceived their access problems to be: (a) a limited range of NGO services available as they felt what are available do not meet their demands; (b) a high service-charge for the healthcare services they sought; (c) higher prices of drugs at the facility compared to the market place; (d) a belief that the NGO clinics are primarily to serve the rich people, (e) lack of experienced doctors at the centres; and (f) the perception that the facility and its services were more oriented to women and children, but not to males. Others responded that they should be allowed to get treatment with credit and, if needed, payment should be waived for some due to their poverty level. While the results of the study revealed many perceptions of barriers to healthcare services by the poor, the feedback provided by the study indicates how important it is to learn from the poorest segment of society. This will assist healthcare providers and the healthcare system itself to become more sensitized to the needs and problems faced by this segment of the society and to make recommendations to remove barriers and improvement of access. Treatment with credit and waived payment for the poorest were also recommended as affordable alternative private healthcare services for the poor

When is Affect Variability Bad for Health? The Association between Affect Variability and Immune Response to the Influenza Vaccination

Objectives—This study addresses methodological and theoretical questions about the association between affect and physical health. Specifically, we examine the role of affect variability and its interaction with mean levels of affect to predict antibody (Ab) levels in response to an influenza vaccination. Methods—Participants (N = 83) received the vaccination and completed daily diary measures of affect four times a day for 13 days. At one and four months post-vaccination, blood was collected from the participants to assess Ab levels. Results—Findings indicate that affect variability and its interaction with mean levels of affect predict an individual’s immune response. Those high in mean positive affect (PA) who had more PA variability were more likely to have a lower Ab response in comparison to those who had high mean PA and less PA variability. Although it did not interact with mean negative affect (NA), NA variability on its own was associated with Ab response, whereby those with less NA variability mounted a more robust immune response. Conclusion—Affect variability is related to immune response to an influenza vaccination and, in some cases, interacts with mean levels of affect. These oscillations in affective experiences are critical to consider in order to unpack the intricacies of how affect influences health. These findings suggest that future researchers should consider the important role of affect variability on physical health-relevant outcomes as well as examine the moderating effect of mean affect levels

Collaborative multidisciplinary learning : quantity surveying students’ perspectives

The construction industry is highly fragmented and is known for its adversarial culture, culminating in poor quality projects not completed on time or within budget. The aim of this study is thus to guide the design of QS programme curricula in order to help students develop the requisite knowledge and skills to work more collaboratively in their multi-disciplinary future workplaces. A qualitative approach was considered appropriate as the authors were concerned with gathering an initial understanding of what students think of multi-disciplinary learning. The data collection method used was a questionnaire which was developed by the Behaviours4Collaboration (B4C) team. Knowledge gaps were still found across all the key areas where a future QS practitioner needs to be collaborative (either as a project contributor or as a project leader) despite the need for change instigated by the multi-disciplinary (BIM) education revolution. The study concludes that universities will need to be selective in teaching, and innovative in reorienting, QS education so that a collaborative BIM education can be effected in stages, increasing in complexity as the students’ technical knowledge grows. This will help students to build the competencies needed to make them future leaders. It will also support programme currency and delivery