Vigilance of Certified Registered Nurse Anesthetists

Vigilance of certified registered nurse anesthetists (CRNAs) is an integral component of the care they provide patients under general anesthetic. the practice of CRNas is important as the official seal of the American Association of Nurse Anesthetists (AANA). on the seal, Morpheus, the god of dreams, is shown holding the Lamp of Learning, by the light of which he keeps vigil (Hirter & Van Nest, 1995). as the patients remain unconscious under general anesthesia, CRNas remain the patients\u27 eyes and ears remains responsive to their needs. the CRNa must remain attentive to the patient\u27s needs by continuously monitoring the patient in the operating room and constantly communicating with the operating room staff. Complete focus must be maintained to avoid any mishaps or adverse events. in essence, CRNas must remain focused and vigilant when caring for their patients. the importance of vigilance is essential and undeniable for optimal patient outcomes, but the process has yet to be defined and understood. Fourteen CRNas participated in phone interviews in this study. CRNas practicing in both hospital and ambulatory settings were included. Through data analysis, using constant comparison, a model emerged that explained vigilance in the CRNa process. the core category was Using Senses, and the model had seven subcategories. the categories below reflected stages in the process model. the process begins with the CRNA\u27s care of the patient (Being Alert). This is when the CRNa assumes care of the patient, maintains a high level of alertness, and does not get mentally fatigued. Being alert allows the CRNa to be ready to care for their patients. When CRNas are alert, they are attentive and engaged (Being Attentive and Engaged) in watching over their patients. This allows the CRNa to be constantly aware and pay attention to their patients. Being attentive and engaged allows the CRNa to be focused (Focusing) on every aspect of patient care. Unfortunately, the operating room is a dynamic environment, where distractions, such as music, conversation, and technology can distract clinicians from being engaged in the care of their patients. These distractions can, but do not always, occur. When they do occur, the CRNa redirects their attention and begins to focus, which allows CRNas to use their senses to look, listen, and feel (Looking, Listening, and Touching). Using the senses of looking, listening, and feeling, the CRNa can pick up on events or look for cues that can help continue or improve care by anticipating changes at random intervals during the case. by using their senses and picking up on cues, the CRNa knows what is going on with the patient (Know What Is Happening). the findings of this study have implications for nurse administrators. This theory will be informative and helpful for hospital administrators, as they may want to implement a policy similar to that which the aviation industry developed for pilots reporting for duty. in regards to nursing research, the Institute of Medicine ([IOM], 2003) has used the phenomena of vigilance and surveillance interchangeably, but the processes are not interchangeable. There is a distinction between these two concepts. This study provides a link between the two phenomena. Vigilance is a link to the process of surveillance and studying it will help the researcher expound upon the previous surveillance research in nursing

Structurally Rich Movement: Measuring Movement for Empirical Psychology and Examining the Dynamic Complexity of Affect Regulation in Behavior

Movement not only permeates human life, but structures dimensions of experience. Phenomenological theory points to the dynamic congruency of movement and emotion, via the body schema, as shaping affectivity. For psychology, this calls for an understanding of behavior beyond being discrete events, but also manifesting kinetic melodies. Yet there is a gap in existing methodology for empirically studying the three-dimensional characteristics of human movement continuously across segments of the body. A potential line of research in this area, implicit affect regulation capacities, was described to inform the selection of instrumentation, measurement, and calculations of dynamic structure that would, theoretically, best measure movement for this and likely other purposes. Regarding instrumentation, an active motion capture system based on the Xbox Kinect and iPiSoft software was selected. Regarding measurement, rotational kinetic energy was identified from the biomechanics literature to meet this requirement. Calculations of dynamic structure focused on a measure of complexity, or structural richness, called multivariate multiscale sample entropy (MMSE). The agreement between the active system and a gold standard passive motion capture system was assessed on two components of rotational kinetic energy, rotational magnitude velocity and segment length, and on dynamic structure calculations. Two MFA actors (one male and one female) and a male professor of theater performed a total of 20 movement sequences, which were concurrently measured by the two systems. The active motion capture system satisfactorily estimated dynamic movement in agreement with the passive system. It also estimated summary measures in high agreement with the passive system. Calculations of dynamic structure were in satisfactory agreement as well. Analyses of MMSE calculations from the active system data provided initial evidence that this process could characterize movement complexity as structural richness, perhaps describable as the body moving as a coherent whole over time. The instrumentation and data processing procedure described in this project can be used to validly measure dynamic movement in psychology. Limitations of the study and future directions in the research and methods are discussed

A Return to State-Led Integrated Regional Planning? Emerging Approaches from Three U.S. States

After decades of neglect, several U.S. states have increased support for regional development planning, creating new programs, organizations, and funding streams to support it. Analysis of programs in three states (New York, Michigan, and Indiana) shows similarities among them as well as contrasts with prior episodes of state-led regional planning. The new programs deliberately sidestep older regional planning organizations like COGs and RPCs in favor of new organizations with larger roles for the private sector and greater access to public funds. The resulting plans focus on individual projects within a pro-development agenda, but still have potential to coordinate action at a regional scale

Misbehavior, Suspensions, and Security Measures in High School: Racial/Ethnic and Gender Differences

This study used merged data from three national surveys to address questions about security measures in American high schools, suspension rates, and student misbehavior. First, the study identified the characteristics of schools that implemented the most extreme security measures and those with the highest levels of discipline. Second, the study used data on individual students to examine misbehavior and race and gender disparities in suspensions not attributable to misbehavior. The main findings were: (1) In-school suspensions serve a ‘gateway’ function with regard to out-of-school suspensions. They may provide a time and place to address behavior problems before they escalate or disproportionate out-of-school suspensions before they occur; (2) Out-of-school suspensions were more frequent among schools in higher-crime neighborhoods. Thus students suspended may be relegated to an environment not conducive to positive educational or social outcomes; (3) African-American students and Hispanic/Latino students were suspended at higher rates than were non-Hispanic whites, differences in most cases not attributable to different levels of misbehavior; (4) Overall, males were more likely to be suspended than were females, an effect above and beyond that explained by differences in behavior. There was little or no difference in the suspension rates of black males and females, however; (5) High degrees of school security were associated with increased suspension rates and increased black – white disparities in total suspensions. At the same time, most black students were enrolled in schools with high degrees of security; (6) Black males were suspended at higher and higher rates as school size increased. All of these have implications for school policy and practice. These are discussed in the paper together with limitations of the investigation

Spoiled Brands: Protecting Your Company\u27s Goodwill and Assets from Food Contamination Claims

For most people, going to a restaurant ends with a sense of satisfaction and enjoyment, not sickness and the possibility of death. This is also true when purchasing products at a local grocery store. However, recent events have cast doubt on the safety of America’s food supply. The issue facing risk managers is how to reduce these escalating risks and manage any unfortunate outcomes. The cost of food contamination can be devastating to a business financially, and can result in both direct losses related to product recall expenses and indirect losses such as lost reputation and goodwill. By reducing the frequency and severity of such risks and using proper risk transfer techniques, risk managers can help prevent catastrophic losses from contaminated food, and ensure the long-term viability of their company\u27s brands

The Gaussian beam mode analysis of off-axis aberrations in long wavelength optical systems

An issue of major concern in the design of long wavelength systems is optical aberration or distortion, which can be particularly severe in off-axis systems. Aberrations occur in both lenses and mirrors and in this paper we present a novel method capable of modelling off-axis mirror configurations. Aberrations degrade fundamental receiver coupling coefficients such as aperture efficiency while increasing spillover power losses. For single pixel instruments this will lead to much longer integration times and the possibility of stray light. For imaging arrays the aberrations cause a departure from perfect point imaging by increasing coupling to array detectors located at angles further off the bore sight of the telescope. This paper verifies a matrix-based scheme using Gaussian beam mode analysis (GBMA) for predicting aberrations from off-axis mirrors. The applied technique was originally described in (S. Withington, A. Murphy, G. Isaak, Representation of mirrors in beam waveguides as inclined phase transforming surfaces, Infrared Phys. Tech. 36(3) (1995) 723–734. [1]) and in this paper we exploit the theory and validate the approach with a series of examples using off-axis conic sections. We present the predictions for both a fundamental Gaussian and a scalar horn field illuminating various off-axis mirror configurations including different angles of incidence. A commercially available physical optics (PO) software package, GRASP8™, is used to validate the accuracy of these scalar GBMA predictions

Behaviour of traffic on a link with traffic light boundaries

This paper considers a single link with traffic light boundary conditions at both ends, and investigates the traffic evolution over time with various signal and system configurations. A hydrodynamic model and a modified stochastic domain wall theory are proposed to describe the local density variation. The Nagel-Schreckenberg model (NaSch), an agent based stochastic model, is used as a benchmark. The hydrodynamic model provides good approximations over short time scales. The domain wall model is found to reproduce the time evolution of local densities, in good agreement with the NaSch simulations for both short and long time scales. A systematic investigation of the impact of network parameters, including system sizes, cycle lengths, phase splits and signal offsets, on traffic flows suggests that the stationary flow is dominated by the boundary with the smaller split. Nevertheless, the signal offset plays an important role in determining the flow. Analytical expressions of the flow in relation to those parameters are obtained for the deterministic domain wall model and match the deterministic NaSch simulations. The analytic results agree qualitatively with the general stochastic models. When the cycle is sufficiently short, the stationary state is governed by effective inflow and outflow rates, and the density profile is approximately linear and independent of time

Variation in Mating Dynamics across Five Species of Leiobunine Harvestmen (Arachnida: Opliones)

The study of mating choices often focuses on correlates of traits to the overall outcome of a mating interaction. However, mating interactions can proceed through a series of stages, with opportunities for assessment at each stage. We compared whether male or female size predicted mating interaction outcome across several stages of mating in five species of North American leiobunine harvestmen (commonly known as daddy longlegs). Leiobunine harvestmen have been previously shown to exhibit incredible morphological diversity consistent with a spectrum of male–female antagonism. Across all of the species, we found a general progression of female size predicting the outcome (success and timing) of early stages of interactions, and male size or male size relative to female size predicting the outcome and timing of later stages of interactions. We also found that size was not a strong predictor of outcome in the two species on the lower end of the antagonism spectrum. The variation in how female and male size predicted outcomes across species and stages of mating suggests that multiple mechanisms may operate to shape mating dynamics within and across species. Given the close relatedness of the species studied, the patterns we uncovered suggest a rapid evolution of the traits and processes predicting the outcome of mating interactions

Associations between birth at, or after, 41 weeks gestation and perinatal encephalopathy: a cohort study

Background Preterm birth causes long-term problems, even for infants born 1 or 2 weeks early. However, less is known about infants born after their due date and over a quarter of infants are born over 1 week late, and many still remain undelivered after 2 weeks. The aim of this work is to quantify the risks of infants developing encephalopathy when birth occurs after the due date, and if other proposed risk factors modify this relationship. Methods The dataset contain information on 4 036 346 infants born in Sweden between 1973 and 2012. Exposure was defined as birth 7, or more, days after the infants’ due date. The primary outcome was the development of neonatal encephalopathy (defined as seizures, encephalopathy or brain injury caused by asphyxia or with unspecified cause). Covariates were selected as presumed confounders a priori. Results 28.4% infants were born 1 or more weeks after their due date. An infant’s risk of being born with encephalopathy was higher in the post 41 weeks group in the unadjusted (OR 1.40 (95% CI 1.32 to 1.49)) and final model (OR 1.38 (95% CI 1.29 to 1.47)), with the relative odds of encephalopathy increasing by an estimated 20% per week after the due date, and modified by maternal age (P=0.022). Conclusions Singleton infants born at, or after, 41 weeks gestation have lower Apgar scores and higher risk of developing encephalopathy in the newborn period, and the association appeared more marked in older mothers. These data could be useful if provided to women as part of their decision-making