Workplace Violence (WPV) Prevention Training Program for a Healthcare Organization

Executive Summary Background and Significance Compared to all other industries in the United States, healthcare professionals are at the greatest risk for experiencing work-related violence (Cafaro et al., 2020; U.S. Bureau of Labor Statistics, 2020). Moreover, patient-to-staff violence, also known as Type Two Workplace Violence (Type 2 WPV), has the highest prevalence to healthcare employees in the past decades (Nowrouzi-Kia et al., 2019). Increasing incidence of Type 2 WPV impacts the health status of medical workers mentally and physically and generates substantial costs to organizations and the society (ILO/ICN/WHO/PSI Joint Program on WPV in the Health Sector, 2002). Thus, there is a need to offer initial training to all healthcare workers to strengthen the management skills in response to the increased prevalence of Type 2 WPV (Adams et al., 2017; Occupational Safety and Health Administration [OSHA], 2015). Problem and Purpose Statement Patient-to-staff violence has a large-scale impact on employees’ safety, physical and psychological well-being (OSHA, 2015). To minimize the prevalence of Type 2 WPV in the healthcare industry, constructive educational interventions are needed to enhance healthcare workers’ knowledge, skills, and competence when managing aggressive behaviors displayed by patients (Michelle A, 2018; Washington State Department of Labor & Industries, 2015). Introducing a Type 2 WPV prevention training program would improve employees\u27 attitudes and confidence levels when facing aggressive behaviors displayed by patients. The purpose of the DNP project was to initiate a Type 2 WPV prevention training program designed to enhance healthcare workers\u27 ability to recognize and manage patient aggression by introducing two validated violence risk identification tools. By initiating an educational intervention, employees would be able to identify violent behaviors and avoid hazardous situations. Therefore, decreasing the long-term incidence of Type 2 WPV. Methods The prevention intervention included a trial educational session and a single group pre/posttest design that measured changes in participant\u27 attitude towards patient aggression. All surveys were conducted by electronic format (Google Form) and participants were prohibited from accessing the PowerPoint educational session until completion of the pre-educational survey. The PowerPoint presentation explained the two validated risk identification tools for common characteristics of violent behaviors: (1) the Aggressive Behavior Risk Assessment Tool (ABRAT), and (2) the Staring, Tone, Anxiety, Mumbling, and Pacing (STAMP). The pre/posttest utilized an evidence-based method to assess participants\u27 attitude change before and after the educational session, the Management of Aggression and Violence Attitude Scale [MAVAS] (Duxbury et al., 2008). Additionally, a self-rating confidence measure (0-10 scale) questionnaire was added to evaluate self-efficacy improvement post-intervention. The data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, adopting a significance level of p \u3c .05. Paired t-tests were used to evaluate the impact of the educational intervention based on data from the two surveys. Results/Outcomes The project was successfully implemented in a community hospital and provided valuable direction in the development of a comprehensive Type 2 WPV prevention training program. Results were measured by a single group pre-and post-intervention surveys, data analyses, and respondents\u27 self-rating confidence level towards violence management. The total number of analyzed samples were 28 (N=28). The outcomes measured displayed an improvement in staff attitudes toward the management of patient aggression after the educational intervention. A statistical significance changed: t(27) = 3.625 (pM= .30, SD= .13, N=28) to the post-intervention survey (M= .36, SD= .11, N=28). In the post-intervention survey, a result showed that participants\u27 confidence level raised by 10% towards patient aggression. Sustainability The educational material will be maintained through the Employee Continual Learning system for newly hired orientation as directed by the administration of the hospitals\u27 safety committee. Additional recommendations included initiate simulation-based training, piloting the risk identification tools, ABRAT into the admission process for aggression perdition, and encouraging Type 2 WPV reporting protocols. An additional oral report and recommendations were presented to the hospital\u27s safety committee. The next step will include sharing project outcomes with Washington State Hospital Association (WSHA) and discussion for dissemination plan of the program to other hospitals members of WSHA. The current COVID-19 pandemic could hinder the execution and should be considered as the barrier for timely implementation in the sustainability plan. Implications for Practice Healthcare workers are at high risk and have a greater chance of being victims of violence in the US. Currently, WPV related training programs include all types of WPV in one package. The findings suggest that a specific educational program focused on Type 2 WPV prevention and management is needed in every organization, which is also recommended by OSHA. The training equips healthcare workers with the knowledge of recognizing violent behavior and initiating proper interferences to perpetrators in time to de-escalate violent situations. A violence prevention program would prepare healthcare workers with the necessary knowledge and confidence to support a safe working environment, increase job satisfaction for all front-line healthcare workers, and provide a quality patient worry-free. Reference Adams, J., Roddy, A., Knowles, A., Ashworth, J., & Irons, G. (2017). Assessing the effectiveness of clinical education to reduce the frequency and recurrence of workplace violence. 34(3), 11. ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector. (2002). Framework guidelines for addressing workplace violence in the health sector. ILO. Cafaro, T., Jolley, C., LaValla, A., Schroeder, R., & Repique, R. J. (n.d.). Workplace Violence Workgroup Report. 3. Duxbury, J., Hahn, S., Needham, I., & Pulsford, D. (2008). The Management of Aggression and Violence Attitude Scale (MAVAS): A cross-national comparative study. Journal of Advanced Nursing, 62(5), 596–606. https://doi.org/10.1111/j.1365-2648.2008.04629.x Michelle A, D., Michelle A. ;Kissinger,Samuel. (2018). Occupational injuries and illnesses among registered nurses _ Monthly Labor Review_ U.S. Bureau of Labor Statistics.pdf. U.S. BUREAU OF LABOR STATISTICS. Nowrouzi-Kia, B., Isidro, R., Chai, E., Usuba, K., & Chen, A. (2019). Antecedent factors in different types of workplace violence against nurses: A systematic review. Aggression and Violent Behavior, 44, 1–7. https://doi.org/10.1016/j.avb.2018.11.002 Occupational Safety and Health Administration. (2015, December). Workplace Violence Prevention and Related Goals: The Big Picture

A Bayesian measurement error model for two-channel cell-based RNAi data with replicates

RNA interference (RNAi) is an endogenous cellular process in which small double-stranded RNAs lead to the destruction of mRNAs with complementary nucleoside sequence. With the production of RNAi libraries, large-scale RNAi screening in human cells can be conducted to identify unknown genes involved in a biological pathway. One challenge researchers face is how to deal with the multiple testing issue and the related false positive rate (FDR) and false negative rate (FNR). This paper proposes a Bayesian hierarchical measurement error model for the analysis of data from a two-channel RNAi high-throughput experiment with replicates, in which both the activity of a particular biological pathway and cell viability are monitored and the goal is to identify short hair-pin RNAs (shRNAs) that affect the pathway activity without affecting cell activity. Simulation studies demonstrate the flexibility and robustness of the Bayesian method and the benefits of having replicates in the experiment. This method is illustrated through analyzing the data from a RNAi high-throughput screening that searches for cellular factors affecting HCV replication without affecting cell viability; comparisons of the results from this HCV study and some of those reported in the literature are included.Comment: Published in at http://dx.doi.org/10.1214/11-AOAS496 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Hydrothermally Grown ZnO Nanoflowers on a Template-Assisted Ordered Seed Array

1-D nanostructure arrays recently attract much attention because of their unique optical, structural, and electronic properties in the field of materials science, microelectronics, and optoelectronic engineering. Zinc Oxide (ZnO) nanoflowers were synthesized by a facile hydrothermal method on a template-assisted deposited ZnO seed array. The ZnO thin film was prepared via a sol-gel spin-coating process on a concave sapphire substrate first. Then an Al layer and an optically clear resin film were individually deposited on the ZnO thin film. After a lift-off process, a convex ZnO seed array film was formed. Finally, ZnO nanoflowers were synthesized by the hydrothermal method at 90oC for 10 to 60 min. The structural, morphological and optical properties of the ZnO nanoflowers were investigated. The XRD results indicate that the ZnO nanoflowers were polycrystalline with a hexagonal wurtzite-type structure with a (002) preferential orientation. The FE-SEM micrographs exhibited the diameter and length of ZnO nanorods increased with the increasing growth time from 10 to 60 min. The 105-nm diameter and 1150-nm length nanorods were obtained with 60-min growth time. Photoluminescence spectra showed a sharp emission peak (IUV) at approximately 380 nm and its intensity increased with the growth time. A weak emission band (IVIS) at 450–550 nm was also observed and the IUV/IVIS increased with the growth time. This result indicates that the defects were reduced and the crystal quality was enhanced with the growth time. The prepared ZnO nanoflowers can be applied to various optoelectronic and sensing devices

Mutations in the PKM2 exon-10 region are associated with reduced allostery and increased nuclear translocation.

PKM2 is a key metabolic enzyme central to glucose metabolism and energy expenditure. Multiple stimuli regulate PKM2's activity through allosteric modulation and post-translational modifications. Furthermore, PKM2 can partner with KDM8, an oncogenic demethylase and enter the nucleus to serve as a HIF1α co-activator. Yet, the mechanistic basis of the exon-10 region in allosteric regulation and nuclear translocation remains unclear. Here, we determined the crystal structures and kinetic coupling constants of exon-10 tumor-related mutants (H391Y and R399E), showing altered structural plasticity and reduced allostery. Immunoprecipitation analysis revealed increased interaction with KDM8 for H391Y, R399E, and G415R. We also found a higher degree of HIF1α-mediated transactivation activity, particularly in the presence of KDM8. Furthermore, overexpression of PKM2 mutants significantly elevated cell growth and migration. Together, PKM2 exon-10 mutations lead to structure-allostery alterations and increased nuclear functions mediated by KDM8 in breast cancer cells. Targeting the PKM2-KDM8 complex may provide a potential therapeutic intervention

Small trocar site hernia after laparoscopy

AbstractThis review article is attempted to review the cases of 5-mm trocar site hernias (TSHs) after laparoscopic surgery and identify the risks associated with incarceration. We searched the English literature on the PubMed website using the key words “trocar site hernia” and “5 mm”. We evaluated a total of 24 cases of 5-mm TSHs and analyzed and results showed that 17 (71%) and 7 (29%) resulted from gynecologic and gastrointestinal surgeries, respectively. The majority were found at the lateral abdomen (87.5%) and recognized within 2 weeks (87.5%). The most frequently herniated organ (n = 14) was the small bowel. Up to 62.5% of cases (n = 15) were repaired by exploratory laparotomy, and 25% (n = 6) required resection of herniated organs secondary to incarceration. The cases with incarceration were detected at 4.3 ± 2.2 days post-operation and those without incarceration at 47.4 days post-operation. No risk factors could be identified to show a correlation between 5-mm TSHs and incarceration. We concluded that immediate 1--2-week postoperative care is of most importance, since the majority of 5-mm trocar site hernias with or without incarceration occurred within this period

Discovery of A New Retrograde Trans-Neptunian Object: Hint of A Common Orbital Plane for Low Semi-Major Axis, High Inclination TNOs and Centaurs

Although the majority of Centaurs are thought to have originated in the scattered disk, with the high-inclination members coming from the Oort cloud, the origin of the high inclination component of trans-Neptunian objects (TNOs) remains uncertain. We report the discovery of a retrograde TNO, which we nickname "Niku", detected by the Pan-STARRS 1 Outer Solar System Survey. Our numerical integrations show that the orbital dynamics of Niku are very similar to that of 2008 KV$_{42}$ (Drac), with a half-life of $\sim 500$ Myr. Comparing similar high inclination TNOs and Centaurs ($q > 10$ AU, $a 60^\circ$), we find that these objects exhibit a surprising clustering of ascending node, and occupy a common orbital plane. This orbital configuration has high statistical significance: 3.8-$\sigma$. An unknown mechanism is required to explain the observed clustering. This discovery may provide a pathway to investigate a possible reservoir of high-inclination objects.Comment: 18 pages, 4 figures, 1 table, accepted for publication in ApJ Letter