Creating a Thriving Informatics Culture

Nurses thrive best when they are empowered to make decisions that can positively impact healthcare delivery. Knowledge and application of nursing informatics principles can influence clinical, quality, operational, and financial outcomes in ways that were not available in previous professional nursing generations. If nursing informatics is the solution, what is the problem? A survey regarding use and attitudes about nursing informatics was taken of chief nurse executives (CNEs) at an integrated, not for profit healthcare system in the Northern California region, where the author oversees the electronic health record (EHR). The results were surprising. Half said they did not know where to locate certain informatics information in the EHR, and 100% wanted training for their leaders in nursing informatics. This need was further magnified when nurse leaders had a multitude of questions about the COVID-19 dashboard that lived within the EHR. A theoretical framework developed by Locsin (2017) provided a framework for an evidence-based intervention in the form of education on a COVID-19 dashboard, which was deployed to nursing leaders to increase the knowledge and application of nursing informatics. Using informatics competencies developed for nurse leaders by the American Association of Colleges of Nursing (AACN) to guide the curriculum, nurse leaders received virtual instruction and guidance to move the informatics dial forward. Pre and post-assessments on learning, using a Likert Scale, measured the effectiveness of the intervention. Results showed significant improvements in nurse leader knowledge and comfort with informatics as it relates to COVID-19 due to the training

The Impact of Exercise Intensity Level on Measures of Mood and Affect

Prescribing the appropriate exercise intensity level for middle-aged individuals can be an especially difficult challenge due to the variations in goals and motivations, as well as health factors in this population group. Often, high intensity levels are avoided out of a fear of the feelings of displeasure that may be created, whereas low-intensity levels may also be avoided as they may are perceived as not being hard enough to be beneficial. PURPOSE: To examine the effects of different intensity levels of aerobic exercise on measures of mood and affect. METHODS: Thirty participants (mean age = 43.6 ± 1.83) completed three exercise sessions of 30-minutes at a comfortable walking pace at an intensity of either 45%, 60%, or 75% of their age-predicted heart rate reserve (HRR) on a motorized treadmill. Participants completed the POMS and AD-ACL surveys prior to and after a 30-min exercise bout at the randomized intensity level. Heart rate (HR) and perceived exertion (RPE) values were measured every 5-min, and treadmill speed and/or incline were adjusted to maintain the selected HRR for the entire exercise bout. After completing the exercise bout, participants once again completed the POMS and AD-ACL. RESULTS: Differences in speed (F2, 56 = 56.88, p \u3c 0.001), HR (F2, 56 = 781.52, p \u3c 0.001), and RPE (F2,58 = 396.86, p \u3c 0.001) were seen for all 3 conditions, with HR (F3, 84 = 98.27, p \u3c 0.001) and RPE (F8, 232 = 21.52, p \u3c 0.001) also increasing significantly across time. POMS total mood disturbance (TMD) scores showed a significant interaction (F2,58 = 23.24, p \u3c 0.001), with TMD decreasing significantly in the 45% HRR (2.30 ± 3.01) condition but increasing significantly during the 75% HRR (24.07 ± 5.29) condition. The 45% HRR condition resulted in greater levels of calmness than the 60% HRR and 75% HRR, and calmness levels did not change from pre- to post-exercise at the 45% or 60% HRR, but did decrease significantly in the 75% HRR (t29 = 2.10, p \u3c 0.05). Energy increased significantly at 45% HRR (t29 = 2.55, p \u3c 0.05) and decreased significantly at 75% HRR (t29 = 3.43. p \u3c 0.01) but did not change at 65% HRR. Tiredness levels did not change from pre- to post-exercise at 45% or 60% HRR but increased significantly at 75% HRR condition (t29 = 7.01, p \u3c 0.001). The 75% HRR resulted in greater levels of tension than in the 45% HRR (p \u3c 0.05) and 60% HRR conditions (p \u3c 0.05), and tension increased significantly at 60% HRR (t29 = 2.07, p \u3c 0.05) and 75% HRR (t29 = 4.55, p \u3c 0.001) but did not change in the 45% HRR condition. CONCLUSION: Exercising at different intensity levels does have a significant effect on mood and affect levels. Exercising at a lower intensity levels decreases tension while also increasing energy and calmness levels, whereas higher intensity exercise increases tension and tiredness while decreasing energy and calmness levels. The results of this study suggest that 45% HRR may be most beneficial for improvements in mood, whereas 75% HRR does seem to result in negative mood states

The financing of terrorism and the threat posed by the Islamic State of Iraq and Levant

The aim of this article is to identify the funding streams that have been exploited by the Islamic State of Iraq and Levant

The origin of deep ocean microseisms in the North Atlantic Ocean

Oceanic microseisms are small oscillations of the ground, in the frequency range of 0.05–0.3 Hz, associated with the occurrence of energetic ocean waves of half the corresponding frequency. In 1950, Longuet-Higgins suggested in a landmark theoretical paper that (i) microseisms originate from surface pressure oscillations caused by the interaction between oppositely travelling components with the same frequency in the ocean wave spectrum, (ii) these pressure oscillations generate seismic Stoneley waves on the ocean bottom, and (iii) when the ocean depth is comparable with the acoustic wavelength in water, compressibility must be considered. The efficiency of microseism generation thus depends on both the wave frequency and the depth of water. While the theory provided an estimate of the magnitude of the corresponding microseisms in a compressible ocean, its predictions of microseism amplitude heretofore have never been tested quantitatively. In this paper, we show a strong agreement between observed microseism and calculated amplitudes obtained by applying Longuet-Higgins' theory to hindcast ocean wave spectra from the North Atlantic Ocean. The calculated vertical displacements are compared with seismic data collected at stations in North America, Greenland, Iceland and Europe. This modelling identifies a particularly energetic source area stretching from the Labrador Sea to south of Iceland, where wind patterns are especially conducive to generating oppositely travelling waves of same period, and the ocean depth is favourable for efficient microseism generation through the ‘organ pipe’ resonance of the compression waves, as predicted by the theory. This correspondence between observations and the model predictions demonstrates that deep ocean nonlinear wave–wave interactions are sufficiently energetic to account for much of the observed seismic amplitudes in North America, Greenland and Iceland

DPP-4 inhibitor dose selection according to manufacturer specifications:A Contemporary Experience From UK General Practice

Recently, 2 dipeptidyl peptidase-4 (DPP-4) inhibitors, sitagliptin and saxagliptin, adjusted dosing specification from creatinine clearance to glomerular filtration rate, more typically reported in routine laboratory tests. This cross-sectional study examines all DPP-4 inhibitor initiations that require dose adjustment and the dose selection using data from UK general practice. Results indicate that 34% of patients taking a nonlinagliptin DPP-4 inhibitor were given a higher dose and 11% a lower dose than specified in the Summary of Product Characteristics. This reinforces the deviation from Summary of Product Characteristics prescription of DPP-4 inhibitors identified in earlier studies despite improvement in compatibility with routine reporting. (C) 2019 The Authors. Published by Elsevier Inc

Mirroring to Build Trust in Digital Assistants

We describe experiments towards building a conversational digital assistant that considers the preferred conversational style of the user. In particular, these experiments are designed to measure whether users prefer and trust an assistant whose conversational style matches their own. To this end we conducted a user study where subjects interacted with a digital assistant that responded in a way that either matched their conversational style, or did not. Using self-reported personality attributes and subjects' feedback on the interactions, we built models that can reliably predict a user's preferred conversational style.Comment: Preprin

Additive manufacturing of bulk refractory fiber within the Ta-Hf-C system for ultra high-temperature reinforced composite materials

This work discusses the production of ultra-high temperature material (UHTM) fibers that can be used to reinforce composite materials in extreme environments. Carbon-fiber-based, carbon-matrix composites are commonly used for many UHTM applications; however within an oxygen containing atmosphere, C-C composites are limited by oxidation well-below their ultimate sublimation temperatures. Hence, research is being carried out to create alternative materials, with very high melting points, but that have greater oxidation resistance. SiC-fiber reinforced composites offer one alternative, but are limited to temperatures below 1870K. Of the 12 binary compounds that have melting points above 3270K, Hafnium Carbide (4170K) and tantalum carbide (4150K) have the highest melting points. The ternary tantalum-hafnium-carbide system, which is derived from hot-isostatically-pressed HfC and TaC powders, has been shown to have a melting point in excess of 4260K. Obviously, these refractory materials are extremely hard to draw/extrude into wires or fibers. In this paper, we demonstrate the first-ever synthesis of Ta-Hf-C compounds in fiber form, where we have used hyperbaric laser chemical vapor deposition (HP-LCVD) to decompose gas-phase precursors. TaC, HfC, and TaxHfyCz fibers were grown from tantalum (V) chloride, hafnium (IV) bromide, and octadecane precursors within a heated glass chamber. Fine-grained and amorphous fibers were grown, depending on the precursor pressures and laser-induced temperatures. Several growth modes were observed, including kinetically-limited and mass-transport limited growth. This additive manufacturing approach holds promise for the bulk fabrication of fine-grained and glassy Ta-Hf-C chopped fiber for UHTM composites, and can be applied to many different material systems. An overview of the HP-LCVD process will be provided, as well as various implementations for producing bulk fiber and microstructures for metal-matrix and ceramic-matrix composites fabrication