The Nurse Manager: An Ethnography of Hospital-Based First-Line Nurse Managers Practicing in an Expanded Role

The behaviors, beliefs and values that characterize everyday practice of first-line nurse managers role were analyzed. Ethnographic field research techniques were used including nine months of observation and in-depth interviews with practicing nurse managers. After reviewing historical events that shaped the role of the nurse manager, the role was then placed within the economic, social and health care context of the 1970\u27s and 80\u27s. Research and anecdotal descriptions of the manager role of the past twenty years were also explored. Research was conducted in two voluntary acute care, multi-service hospitals. One manager was observed intensively for two months to develop a semi structured open-ended interview guide. The guide was then used to conduct extensive ethnographic interviews with 16 inpatient managers. In addition, six nurse administrators were interviewed, institutional documents examined and a variety of techniques used to triangulate observations and theories that emerged and to examine issues of validity and reliability. Managers described their role as four processes: (1) social control, establishing, monitoring and maintaining standards; (2) resourcing, the provision of emotional support, goods and services; (3) translating/ interpreting/negotiating among unit-based or related constituencies; and, (4) facilitating change. Administrators concurred with the managers\u27 descriptions emphasizing social control. Managers described themselves as desiring control/power to make beneficial changes; being stimulated by a changing work environment and deriving satisfaction from staff development. They identified essential skills for role enactment as communication/interpersonal expertise, clinical knowledge, flexibility, a strong ego and political savvy. The study then examined how managers analyze the complexity of change, alter their management strategies accordingly and create a working culture that is maximally adaptable to an unstable health care environment. They identified ways to enhance success and avoid or respond to failure, using knowledge acquired primarily through experience. Finally, the study examined the common culture of nursing management within the context of its historical roots, particularly the necessity for a bicultural identity that incorporates beliefs and values of both manager/employee and professional clinician/nurse. Structured mentoring was explored as a bridging strategy to enhance enculturation and skill acquisition

A non-linear observer for unsteady three-dimensional flows

A method is proposed to estimate the velocity field of an unsteady flow using a limited number of flow measurements. The method is based on a non-linear low-dimensional model of the flow and on expanding the velocity field in terms of empirical basis functions. The main idea is to impose that the coefficients of the modal expansion of the velocity field give the best approximation to the available measurements and that at the same time they satisfy as close as possible the non-linear low-order model. The practical use may range from feedback flow control to monitoring of the flow in non-accessible regions. The proposed technique is applied to the flow around a confined square cylinder, both in two- and three-dimensional laminar flow regimes. Comparisons are provided. with existing linear and non-linear estimation techniques

Experiments in lifelog organisation and retrieval at NTCIR

Lifelogging can be described as the process by which individuals use various software and hardware devices to gather large archives of multimodal personal data from multiple sources and store them in a personal data archive, called a lifelog. The Lifelog task at NTCIR was a comparative benchmarking exercise with the aim of encouraging research into the organisation and retrieval of data from multimodal lifelogs. The Lifelog task ran for over 4 years from NTCIR-12 until NTCIR-14 (2015.02–2019.06); it supported participants to submit to five subtasks, each tackling a different challenge related to lifelog retrieval. In this chapter, a motivation is given for the Lifelog task and a review of progress since NTCIR-12 is presented. Finally, the lessons learned and challenges within the domain of lifelog retrieval are presented

Interventions to support people exposed to adverse childhood experiences : systematic review of systematic reviews

BACKGROUND: Adverse Childhood Experiences (ACEs) such as abuse, neglect or household adversity may have a range of serious negative impacts. There is a need to understand what interventions are effective to improve outcomes for people who have experienced ACEs. METHODS: Systematic review of systematic reviews. We searched 18 database sources from 2007 to 2018 for systematic reviews of effectiveness data on people who experienced ACEs aged 3-18, on any intervention and any outcome except incidence of ACEs. We included reviews with a summary quality score (AMSTAR) of 5.5 or above. RESULTS: Twenty-five reviews were included. Most reviews focus on psychological interventions and mental health outcomes. The strongest evidence is for cognitive-behavioural therapy for people exposed to abuse. For other interventions - including psychological therapies, parent training, and broader support interventions - the findings overall are inconclusive, although there are some positive results. CONCLUSIONS: There are significant gaps in the evidence on interventions for ACEs. Most approaches focus on mitigating individual psychological harms, and do not address the social pathways which may mediate the negative impacts of ACEs. Many negative impacts of ACEs (e.g. on health behaviours, social relationships and life circumstances) have also not been widely addressed by intervention studies

A clinically interpretable convolutional neural network for the real time prediction of early squamous cell cancer of the esophagus; comparing diagnostic performance with a panel of expert European and Asian endoscopists

BACKGROUND AND AIMS: Intrapapillary capillary loops (IPCLs) are microvascular structures that correlate with invasion depth of early squamous cell neoplasia (ESCN) and allow accurate prediction of histology. Artificial intelligence may improve human recognition of IPCL patterns and prediction of histology to allow prompt access to endoscopic therapy of ESCN where appropriate METHODS: One hundred fifteen patients were recruited at 2 academic Taiwanese hospitals. ME-NBI videos of squamous mucosa were labeled as dysplastic or normal according to their histology and IPCL patterns classified by consensus of 3 experienced clinicians. A convolutional neural network (CNN) was trained to classify IPCLs, using 67742 high quality ME-NBI by 5-fold cross validation. Performance measures were calculated to give an average F1 score, accuracy, sensitivity, and specificity. A panel of 5 Asian and 4 European experts predicted the histology of a random selection of 158 images using the JES IPCL classification; accuracy, sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: Expert European Union (EU) and Asian endoscopists attained F1 scores (a measure of binary classification accuracy) of 97.0% and 98%, respectively. Sensitivity and accuracy of the EU and Asian clinicians were 97%, 98% and 96.9%, 97.1% respectively. The CNN average F1 score was 94%, sensitivity 93.7% and accuracy 91.7%. Our CNN operates at video rate and generates class activation maps that can be used to visually validate CNN predictions. CONCLUSIONS: We report a clinically interpretable CNN developed to predict histology based on IPCL patterns, in real-time, using the largest reported dataset of images for this purpose. Our CNN achieved diagnostic performance comparable to an expert panel of endoscopists

Parental smoking and childhood cancer: results from the United Kingdom Childhood Cancer Study

There are strong a priori reasons for considering parental smoking behaviour as a risk factor for childhood cancer but case – control studies have found relative risks of mostly only just above one. To investigate this further, self-reported smoking habits in parents of 3838 children with cancer and 7629 control children included in the United Kingdom Childhood Cancer Study (UKCCS) were analysed. Separate analyses were performed for four major groups (leukaemia, lymphoma, central nervous system tumours and other solid tumours) and more detailed diagnostic subgroups by logistic regression. In the four major groups, after adjustment for parental age and deprivation there were nonsignificant trends of increasing risk with number of cigarettes smoked for paternal preconception smoking and nonsignificant trends of decreasing risk for maternal preconception smoking (all P-values for trend >0.05). Among the diagnostic subgroups, a statistically significant increased risk of developing hepatoblastoma was found in children whose mothers smoked preconceptionally (OR=2.68, P=0.02) and strongest (relative to neither parent smoking) for both parents smoking (OR=4.74, P=0.003). This could be a chance result arising from multiple subgroup analysis. Statistically significant negative trends were found for maternal smoking during pregnancy for all diagnoses together (P<0.001) and for most individual groups, but there was evidence of under-reporting of smoking by case mothers. In conclusion, the UKCCS does not provide significant evidence that parental smoking is a risk factor for any of the major groups of childhood cancers

Addressing risk factors for child abuse among high risk pregnant women: design of a randomised controlled trial of the nurse family partnership in Dutch preventive health care

<p>Abstract</p> <p>Background</p> <p>Low socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s). Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States.</p> <p>Methods</p> <p>The study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present.</p> <p>Discussion</p> <p>This study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN16131117">ISRCTN16131117</a></p

Living alone is a risk factor for mortality in men but not women from the general population: a prospective cohort study

During the past decades a rising trend of living alone can be observed in the population especially in urban areas. Living alone is considered a psychosocial risk factor. We studied the relationship between living alone, cardiovascular risk factors and mortality. We analysed data from the population-based MONICA/KORA cohort study including 3596 men and 3420 women of at least one of three surveys carried out between 1984 and 1995 in the region of Augsburg, Germany. They were between 45 and 74 years old and were followed-up until 31 December 2002. During follow-up 811 men and 388 women died. Cox proportional hazards analysis was used to examine the association between living alone and mortality

Symptoms of anxiety and depression are related to cardiovascular responses to active, but not passive, coping tasks

Objective: Anxiety and depression have been linked to blunted blood pressure (BP) and heart rate (HR) reactions to mental stress tests; however, most studies have not included indices of underlying hemodynamics nor multiple stress tasks. This study sought to examine the relationships of anxiety and depression with hemodynamic responses to acute active and passive coping tasks. Methods: A total of 104 participants completed the Hospital Anxiety and Depression Scales and mental arithmetic, speech, and cold pressor tasks while BP, HR, total peripheral resistance, and cardiac output (CO) were assessed. Results: After adjustment for traditional risk factors and baseline cardiovascular activity, depression scores were negatively associated with systolic BP, HR, and CO responses to the mental arithmetic task, while anxiety scores were inversely related to the systolic BP response to mental arithmetic. Conclusion: High anxiety or depression scores appear to be associated with blunted cardiac reactions to mental arithmetic (an active coping task), but not to the cold pressor test or speech tasks. Future research should further examine potential mechanisms and longitudinal pathways relating depression and anxiety to cardiovascular reactivity