Individual Nurse Productivity in Preparing Patients for Discharge Is Associated with Patient Likelihood of 30-Day Return to Hospital

Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P\u3c0.001) and an ED visit (−0.29 absolute percentage points, P=0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes

The stability of “Ce2O3” nanodots in ambient conditions: a study using block copolymer templated structures

The stability of reduced cerium oxide in ambient conditions is clearly demonstrated in this paper. Well-defined, crystalline, cerium oxide nanodots (predominantly Ce4+ or Ce3+ material could be selectively prepared) were defined at silicon substrate surfaces by a method of block copolymer templating. Here, selective addition of the cerium ion into one block via solvent inclusion and subsequent UV/ozone processing resulted in the formation of well-separated, size mono-dispersed, oxide nanodots having a hexagonal arrangement mimicking that of the polymer nanopattern. The size of the dots could be varied in a facile manner by controlling the metal ion content. Synthesis and processing conditions could be varied to create nanodots which have a Ce2O3 type composition. The stability of the sesquioxide type structure under processing (synthesis) conditions and calcination was explored. Surprisingly, the sesquioxide type structure appears to be reasonably stable in ambient conditions with little evidence for extensive oxidation until heating to temperatures above ambient. Room temperature fluorescence is supposed to originate from a distribution of surface or defect states and depends on preparation conditions

Measurement of brain lactate during visual stimulation using a long TE semi‐LASER sequence at 7 T

Estimation of metabolic changes during neuronal activation represents a challenge for in vivo MRS, especially for metabolites with low concentration and signal overlap, such as lactate. In this work, we aimed to evaluate the feasibility of detecting lactate during brain activation using a long urn:x-wiley:nbm:media:nbm4223:nbm4223-math-0001 (144 ms) semi‐LASER sequence at 7 T. urn:x-wiley:nbm:media:nbm4223:nbm4223-math-0002 spectra were acquired on healthy volunteers ( urn:x-wiley:nbm:media:nbm4223:nbm4223-math-0003) during a paradigm with 15 min of visual stimulation. Outer‐volume signals were further attenuated by the use of saturation slabs, and macromolecular signals in the vicinity of the inverted lactate peak were individually fitted with simulated Lorentzian peaks. All spectra were free of artefacts and highly reproducible across subjects. Lactate was accurately quantified with an average Cramér‐Rao lower bound of 8%. Statistically significant ( urn:x-wiley:nbm:media:nbm4223:nbm4223-math-0004, one‐tailed urn:x-wiley:nbm:media:nbm4223:nbm4223-math-0005‐test) increases in lactate ( urn:x-wiley:nbm:media:nbm4223:nbm4223-math-000610%) and glutamate ( urn:x-wiley:nbm:media:nbm4223:nbm4223-math-00073%) levels during stimulation were detected in the visual cortex. Lactate and glutamate changes were consistent with previous measurements. We demonstrated that quantification of a clear and non‐contaminated lactate peak obtained with a long TE sequence has the potential of improving the accuracy of functional MRS studies targeting non‐oxidative reaction pathways

tDCS-induced alterations in GABA concentration within primary motor cortex predict motor learning and motor memory: A 7T magnetic resonance spectroscopy study

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that alters cortical excitability in a polarity specific manner and has been shown to influence learning and memory. tDCS may have both on-line and after-effects on learning and memory, and the latter are thought to be based upon tDCS-induced alterations in neurochemistry and synaptic function. We used ultra-high-field (7 T) magnetic resonance spectroscopy (MRS), together with a robotic force adaptation and de-adaptation task, to investigate whether tDCS-induced alterations in GABA and Glutamate within motor cortex predict motor learning and memory. Note that adaptation to a robot-induced force field has long been considered to be a form of model-based learning that is closely associated with the computation and ‘supervised’ learning of internal ‘forward’ models within the cerebellum. Importantly, previous studies have shown that on-line tDCS to the cerebellum, but not to motor cortex, enhances model-based motor learning. Here we demonstrate that anodal tDCS delivered to the hand area of the left primary motor cortex induces a significant reduction in GABA concentration. This effect was specific to GABA, localised to the left motor cortex, and was polarity specific insofar as it was not observed following either cathodal or sham stimulation. Importantly, we show that the magnitude of tDCS-induced alterations in GABA concentration within motor cortex predicts individual differences in both motor learning and motor memory on the robotic force adaptation and de-adaptation task

Novel Family of Gynecologic Cancer Antigens Detected by Anti-HIV Antibody

Objective: The reactivity of gynecologic cancer proteins with monoclonal antibody (MAb) directed against the human immunodeficiency virus I (HIV-I) was tested

Performance potential of an advanced technology Mach 3 turbojet engine installed on a conceptual high-speed civil transport

The performance of an advanced technology conceptual turbojet optimized for a high-speed civil aircraft is presented. This information represents an estimate of performance of a Mach 3 Brayton (gas turbine) cycle engine optimized for minimum fuel burned at supersonic cruise. This conceptual engine had no noise or environmental constraints imposed upon it. The purpose of this data is to define an upper boundary on the propulsion performance for a conceptual commercial Mach 3 transport design. A comparison is presented demonstrating the impact of the technology proposed for this conceptual engine on the weight and other characteristics of a proposed high-speed civil transport. This comparison indicates that the advanced technology turbojet described could reduce the gross weight of a hypothetical Mach 3 high-speed civil transport design from about 714,000 pounds to about 545,000 pounds. The aircraft with the baseline engine and the aircraft with the advanced technology engine are described

The relationship between transcription initiation RNAs and CCCTC-binding factor (CTCF) localization

Background: Transcription initiation RNAs (tiRNAs) are nuclear localized 18 nucleotide RNAs derived from sequences immediately downstream of RNA polymerase II (RNAPII) transcription start sites. Previous reports have shown that tiRNAs are intimately correlated with gene expression, RNA polymerase II binding and behaviors, and epigenetic marks associated with transcription initiation, but not elongation. Results: In the present work, we show that tiRNAs are commonly found at genomic CCCTC-binding factor (CTCF) binding sites in human and mouse, and that CTCF sites that colocalize with RNAPII are highly enriched for tiRNAs. To directly investigate the relationship between tiRNAs and CTCF we examined tiRNAs originating near the intronic CTCF binding site in the human tumor suppressor gene, p21 (cyclin-dependent kinase inhibitor 1A gene, also known as CDKN1A). Inhibition of CTCF-proximal tiRNAs resulted in increased CTCF localization and increased p21 expression, while overexpression of CTCF-proximal tiRNA mimics decreased CTCF localization and p21 expression. We also found that tiRNA-regulated CTCF binding influences the levels of trimethylated H3K27 at the alternate upstream p21 promoter, and affects the levels of alternate p21 (p21) transcripts. Extending these studies to another randomly selected locus with conserved CTCF binding we found that depletion of tiRNA alters nucleosome density proximal to sites of tiRNA biogenesis. Conclusions: Taken together, these data suggest that tiRNAs modulate local epigenetic structure, which in turn regulates CTCF localization

Organic functionalization of germanium nanowires using arenediazonium salts

The formation of organic functionalization layers on germanium (Ge) nanowires was investigated using a new synthetic protocol employing arenediazonium salts. Oxide-free, H-terminated Ge nanowires were immersed in diazonium salt/acetonitrile solutions and the molecular interface of the functionalized nanowires was analyzed by reflectance infrared spectroscopy and X-ray photoelectron spectroscopy. The morphology of the modified nanowires was investigated by electron microscopy. Surface functionalization of the nanowires was found to be slow at room temperature, but proceeded efficiently with moderate heating (50 °C). The use of arenediazonium salts can result in the formation of aryl multilayers, however the thickness and uniformity of the organic layer was found to be strongly influenced by the nature of the substituents on the aromatic ring. Substituents attached to the 3-, 4-, and 5-ring positions hindered the formation of multilayers, while the presence of sterically bulky ring substituents affected the homogeneity of the organic layers. We successfully demonstrate that arenediazonium salts are very flexible precursors for nanowire functionalization, with the possibility to covalently attach a wide variety of aromatic ligands, offering the potential to alter the thickness of the resulting outer organic shell