Use of Pain Management Champions to Enhance Guideline Implementation by Care Workers in Nursing Homes

Underutilization of evidence-based pain management in nursing homes (NHs) is common. Evidence toward effective approaches to improve adoption of evidence-based practices in NHs is limited. Application of theory in evaluation approaches can increase understanding of implementation challenges.; To get a better understanding of the impact of implementation strategies by exploring the underlying mechanisms using behavioral theory.; This mixed-methods study is embedded in an implementation-effectiveness study of a pain management guideline in four Swiss NHs. To evaluate our implementation strategies, training workshops were held, and trained pain champions were introduced. We also developed a conceptual framework. Based on Bandura's self-efficacy theory, we hypothesized how our implementation strategies might affect changes in care workers' behavior. Care workers' questionnaire surveys were conducted at baseline (n = 136), after 3 months (n = 99), and after 6 months (n = 83) to assess self-efficacy in pain management and self-reported guideline adoption. We computed linear mixed-effect models to assess changes over time in self-efficacy and logistic regressions to assess associations between self-efficacy and guideline adoption. Concurrently, we conducted focus groups with care workers (n = 8) to explore their response to the implementation strategies.; Overall, there was a significant increase in self-efficacy at both time points (p < .001). We found significant associations between self-efficacy and adoption of two guideline components, that is, performing a comprehensive pain assessment and using observational pain assessment tools in cognitively impaired residents. Qualitative findings showed that implementation strategies were received positively by care workers. Focus group participants reported more attentiveness to residents' pain experience. The participants also reported increases in assessment and documentation of pain with more detail than before.; Our findings highlighted that the training and use of pain champions increased self-efficacy and thereby induced behavior change leading to guideline adoption. Regarding persistent implementation challenges, a theory-based conceptual model contributes to the overall understanding

Skills, earnings, and employment: exploring causality in the estimation of returns to skills

Ample evidence indicates that a person’s human capital is important for success on the llabor market in terms of both wages and employment prospects. However, unlike the efforts to identify the impact of school attainment on labor-market outcomes, the literature on returns to cognitive skills has not yet provided convincing evidence that the estimated returns can be causally interpreted. Using the PIAAC Survey of Adult Skills, this paper explores several approaches that aim to address potential threats to causal identification of returns to skills, in terms of both higher wages and better employment chances. We address measurement error by exploiting the fact that PIAAC measures skills in several domains. Furthermore, we estimate instrumental-variable models that use skill variation stemming from school attainment and parental education to circumvent reverse causation. Results show a strikingly similar pattern across the diverse set of countries in our sample. In fact, the instrumental-variable estimates are consistently larger than those found in standard least-squares estimations. The same is true in two "natural experiments," one of which exploits variation in skills from changes in compulsory-schooling laws across U.S. states. The other one identifies technologically induced variation in broadband Internet availability that gives rise to variation in ICT skills across German municipalities. Together, the results suggest that least-squares estimates may provide a lower bound of the true returns to skills in the labor market

On Lossless Compression of 1-bit Audio Signals

In this paper we consider the problem of lossless compression of 1-bit audio signals. We study the properties of some existing proposed solutions. We also discuss possible improvements. Other methods have been considered, and the results are reported

14C contamination testing in natural abundance laboratories: a new preparation method using wet chemical oxidation and some experiences

Substances enriched with radiocarbon can easily contaminate samples and laboratories used for natural abundance measurements. We have developed a new method using wet chemical oxidation for swabbing laboratories and equipment to test for 14C contamination. Here, we report the findings of 18 months’ work and more than 800 tests covering studies at multiple locations. Evidence of past and current use of enriched 14C was found at all but one location and a program of testing and communication was used to mitigate its effects. Remediation was attempted with mixed success and depended on the complexity and level of the contamination. We describe four cases from different situations

Ceria-Based Dual-Phase Membranes for High-Temperature Carbon Dioxide Separation: Effect of Iron Doping and Pore Generation with MgO Template

Dual-phase membranes for high-temperature carbon dioxide separation have emerged as promising technology to mitigate anthropogenic greenhouse gases emissions, especially as a pre- and post-combustion separation technique in coal burning power plants. To implement these membranes industrially, the carbon dioxide permeability must be improved. In this study, Ce0.8Sm0.2O2−δ (SDC) and Ce0.8Sm0.19Fe0.01O2−δ (FSDC) ceramic powders were used to form the skeleton in dual-phase membranes. The use of MgO as an environmentally friendly pore generator allows control over the membrane porosity and microstructure in order to compare the effect of the membrane’s ceramic phase. The ceramic powders and the resulting membranes were characterized using ICP-OES, HSM, gravimetric analysis, SEM/EDX, and XRD, and the carbon dioxide flux density was quantified using a high-temperature membrane permeation setup. The carbon dioxide permeability slightly increases with the addition of iron in the FSDC membranes compared to the SDC membranes mainly due to the reported scavenging effect of iron with the siliceous impurities, with an additional potential contribution of an increased crystallite size due to viscous flow sintering. The increased permeability of the FSDC system and the proper microstructure control by MgO can be further extended to optimize carbon dioxide permeability in this membrane system.DFG, 414044773, Open Access Publizieren 2019 - 2020 / Technische Universität Berli

A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes

As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies. An explanatory sequential mixed-methods study embedded in a cross-sectional study in 20 Swiss nursing homes (data collection: July-December 2016). Quantitative data were collected via care worker questionnaire surveys comprising 20 items assessing perceptions of barriers to pain management. Descriptive statistics were computed. In the subsequent qualitative strand we conducted four focus group discussions with care workers (registered nurses, licensed practical nurses, and nursing aides) using a knowledge-mapping approach. Findings of both strands were merged and mapped onto domains of the Capability, Opportunity, and Motivation determine Behavior (COM-B) system, a model for behavior, to identify determinants for behavior change. Data from 343 completed care worker surveys (response rate 67.3%) and four focus groups with care workers were analyzed. Items rated most problematic were as follows: lack of availability of nonpharmacological treatment (60.9%), lack of application of nonpharmacological treatment (53.6%), reluctance of residents to report pain (51.1%), and lack of time for a comprehensive pain assessment (50.5%). Focus groups partly corroborated quantitative findings and complemented them with facilitators, such as close collaboration with physicians and further barriers (e.g., organizational factors such as high turnover and a lack of established routines in pain management). Our approach using a behavioral model highlighted a need for implementation strategies that improve pain management knowledge and focus on motivational aspects to establish new routines and habits related to pain management among care workers. Our findings suggest that future approaches to improve pain management in nursing homes should go beyond provision of education and training. To establish new practices or adapt existing ones, a more complex approach (e.g., introduction of external or internal facilitators) is necessary to influence motivation and ultimately change behavior

Fully Dynamic Algorithms for Knapsack Problems with Polylogarithmic Update Time

Knapsack problems are among the most fundamental problems in optimization. In the Multiple Knapsack problem, we are given multiple knapsacks with different capacities and items with values and sizes. The task is to find a subset of items of maximum total value that can be packed into the knapsacks without exceeding the capacities. We investigate this problem and special cases thereof in the context of dynamic algorithms and design data structures that efficiently maintain near-optimal knapsack solutions for dynamically changing input. More precisely, we handle the arrival and departure of individual items or knapsacks during the execution of the algorithm with worst-case update time polylogarithmic in the number of items. As the optimal and any approximate solution may change drastically, we maintain implicit solutions and support polylogarithmic time query operations that can return the computed solution value and the packing of any given item. While dynamic algorithms are well-studied in the context of graph problems, there is hardly any work on packing problems (and generally much less on non-graph problems). Motivated by the theoretical interest in knapsack problems and their practical relevance, our work bridges this gap

The Interaction Between Leadership, the Patient-to-Nurse Ratio and Nurses' Work-Life Balance in the Psychiatric Inpatient Setting in Switzerland: A Secondary Data Analysis of Cross-Sectional Data

Psychiatric nurses' work environment factors, including long hours, heavy workloads and leadership issues, can serve as barriers to achieving a healthy work-life balance. However, for both individuals and organizations, that balance is crucial as it is a key determinant of job satisfaction and leaving intentions. To address the limiting evidence to that topic, this study had two objectives: (1) to describe the work-life balance of nurses working in psychiatric inpatient settings; and (2) to examine those nurses' work-life balance and its associations with individual (i.e., age, gender), psychosocial (i.e., leadership) and structural factors (i.e., employment percentage). To analyze these factors and their impacts, we conducted a cross-sectional study in a sample of 1209 nurses from 116 units in 13 psychiatric hospitals of the German-speaking part of Switzerland and analyzed the resulting data via multilevel analysis. This led to three main results. First, nurses reported a high mean value regarding their work-life balance. Second, multivariable regression results indicated that their work-life balance ratings correlated directly with certain psychosocial work environment factors (leadership and support of nurses, perceived staffing resources) and inversely with structural factors (employment percentage, overtime). And third, we found an interaction between leadership and support of nurses and the patient-to-nurse ratio: the lower the leadership level, the stronger the inverse association between patient load and work-life balance. No individual factors were significantly associated with work-life balance. Overall, though, we found that organizational factors are vital to nurses' work-life balance. Therefore, interventions to improve nurses' work-life balance should be institution-level, and should focus on improving either leadership or structural factors, e.g., employment percentage, overtime, and patient-to-nurse ratios