The Use of a Patient Mobility Sensor to Decrease Hospital-Acquired Pressure Ulcers

Pressure ulcers are a serious health condition that have negative consequences for patients and organizations. The primary cause of pressure ulcers is intense and/or prolonged pressure or pressure in combination with shear that results in damage to the skin and underlying soft tissue. Early identification of patients at risk for pressure ulcers and 2-hour repositioning to off-load pressure are key components in reducing pressure ulcer development. Despite ongoing efforts to prevent pressure ulcers, the incidence and prevalence of hospital-acquired pressure ulcers (HAPUs) at the practicum site exceeded the benchmark for Magnet hospitals and the health system\u27s goal of 1%. Patient mobility sensor technology will be implemented on all patients who are at risk for pressure ulcers and who require caregiver-assisted turns to reduce the incidence and prevalence of HAPUs and increase turn-schedule compliance. At risk patients are those with a Braden Scale score of 18 or less; however, nurses often score patients higher than actual. An educational activity, Braden Scale for Predicting Pressure Sore Risk: It\u27s only as effective as the scores suggest, will be presented to nurses to provide them with the knowledge and skills necessary to accurately perform a Braden assessment and correctly identify patients at risk for pressure ulcers. A pretest/posttest design will be used to evaluate the effectiveness of the program in improving the nurses\u27 accuracy when performing the Braden assessment. This project will help with the early identification of patients who will benefit from the patient mobility sensor technology and ultimately in decreasing HAPUs

Peptide transport in Candida albicans and synthetic antifungal agents

These studies have characterized the peptide transport systems of Candida albicans, with a view to the rational design of peptide antifungal agents exploiting the 'smugglin' concept. In initial studies, a series of polyoxin complexes (peptide-nucleoside antibiotics) and individual components, were isolated from a batch of agricultural fungicide (Polyoxin Z). Isolated fractions were toxic to a particulate chitin synthetase preparation from Candida albicans. Different strains of Candida albicans exhibited varied sensitivities to a series of peptide analogues. From a sensitive strain, B2630, spontaneous mutants were selected for resistance to each analogue; certain mutants showed cross-resistance to other analogues and associated defects in peptide transport. A bacilysin-resistant mutant was cross-resistant to the other analogues and to m- fluorophenylalanylalanylalanine a but retained sensitivity to m- fluorophenylalanylalanylalanine. This mutant showed defective dipeptide transport but normal oligopeptide transport, and was unable to utilize Ala-Ala as a sole nitrogen source. Thus, Candida albicans has distinguishable mechanisms for dipeptide and oligopeptide transport which can be exploited for uptake of peptide-drug adducts. Peptide transport was shown to be stimulated by the presence of peptides (peptone) in the growth medium. On transferring cells from minimal to peptone medium, this stimulatory effect was shown to be rapid, independent of protein synthesis and to override ammonia regulation of peptide transport. The reduction of transport activity on transferring cells from peptone to minimal medium was also rapid. It was speculated that regulation of peptide transport is achieved by a rapid, reversible activation of preformed transport components, or a mechanism of exocytotic insertion and endocytic retrieval of preformed transporters. The effect of protein-modification reagents on transport activity was also examined. Dipeptide transport was specifically inhibited by N-ethyl-5-phenylisoxazolium-3'-sulphonate (Woodwards Reagent K), offerring potential for the specific labelling of the component(s) of this system. Peptide transport was shown not to be sensitive to osmotic shock though a series of uncharacterized polypeptides was released by the shock treatment

Strategies for Effective Financial Management in Vincentian Small Businesses

The lack of strategies for effective financial management has been an impediment to the survival and growth of many small businesses in Saint Vincent (St. Vincent), an island in the Caribbean. Inadequate adoption of strategies by small business owners is a prime contributing factor to small business failure. The purpose of this research was to identify strategies that small business owners use for effective financial management. Institutional theory served as the conceptual framework for this multiple case study. Participants consisted of 4 St. Vincent small business owners who had demonstrated effective financial management strategies in the operation of their businesses. Data collection occurred through semistructured interviews and a review of documentation, which was complemented by the use of member checking to strengthen the credibility and trustworthiness of findings. Three themes emerged through thematic data analysis: (a) strategic accounting practices, (b) set patterns, and (c) financial planning. Prudent accounting practices and sound financial planning are to be standard adoption by small business owners to have effective financial management. A conclusion, based on study findings, is that identification and implementation of effective financial management strategies may increase small business success, potentially resulting in growth in the number of small businesses in St. Vincent and an improved economy. Subsequent positive social change for Vincentians may include poverty reduction, lower unemployment, and a diminished crime rate

Exploring midwives' interactions with mothers when labour begins: A study using participatory action research.

to explore the interactions between mothers and midwives when labour begins with a focus on midwives and unexpected birth out of hospital. participatory action research (PAR) that sought to understand and improve interactions between mothers and midwives through interviews, focus groups and a joint workshop. maternity services in the north of England, in a district general hospital with one obstetric unit and two birth centres, across two sites and where there was a birth rate of 6000. a total of 72 participants took part in the study. Thirteen mothers and five midwives were interviewed. Seven mothers were interviewed who had contacted a midwife in labour and subsequently given birth unexpectedly out of hospital. Thirty-one mothers and twenty-three midwives took part in a series of ten focus groups. three major themes were identified from the midwives' data: 'Formulaic discourse as self-protection', 'One to one or one to everyone' and 'Interactions and time'. The latter theme is discussed in this paper showing that when midwifery activity was high and they did not have enough time, midwives experienced a high degree of conflicting emotions such as fear, helplessness and frustration, which stretched their personal and professional integrity and triggered changes in their thinking and behaviour. current maternity services appear constrained by a reduced midwifery workforce that is expected to meet excessive organisational demands whilst coping with reduced bed capacity. These pressures can promote changes in midwives' behaviour and thinking which disconnects them from mothers rather than focussing on their needs. Safety depends on a high degree of midwife to mother continuity. However, a business model approach, prioritising throughput and process promotes fragmented care and can potentially threaten the safety of mothers and babies. In this study, there appears to be a link between disconnected interactions when labour begins and mothers giving birth unexpectedly out of hospital. [Abstract copyright: Copyright © 2018. Published by Elsevier Ltd.

The Means/Side-Effect Distinction in Moral Cognition: A Meta-Analysis

Experimental research suggests that people draw a moral distinction between bad outcomes brought about as a means versus a side effect (or byproduct). Such findings have informed multiple psychological and philosophical debates about moral cognition, including its computational structure, its sensitivity to the famous Doctrine of Double Effect, its reliability, and its status as a universal and innate mental module akin to universal grammar. But some studies have failed to replicate the means/byproduct effect especially in the absence of other factors, such as personal contact. So we aimed to determine how robust the means/byproduct effect is by conducting a meta-analysis of both published and unpublished studies (k = 101; 24,058 participants). We found that while there is an overall small difference between moral judgments of means and byproducts (standardized mean difference = 0.87, 95% CI 0.67 – 1.06; standardized mean change = 0.57, 95% CI 0.44 – 0.69; log odds ratio = 1.59, 95% CI 1.15 – 2.02), the mean effect size is primarily moderated by whether the outcome is brought about by personal contact, which typically involves the use of personal force