Assessing time use in long-term institutional care:development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC)

BACKGROUND: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language. METHODS: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero. RESULTS: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found. CONCLUSIONS: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services

Employer-Sponsored Small-Dollar Loans: An Assessment of Take-Up, Engagement, and Outcomes

Employees financial wellness program (EFWPs) are gaining in popularity as a strategy to address workers\u27 financial challenges and goals beyond offering health and retirement benefits. Most workers say they are stressed about their finances1 and a third are less productive at work because of this stress.2 Although employers are increasingly interested in offering EFWPs, little research has been conducted concerning these workplace financial products and services

Auswirkungen mechanischer Beikrautregulierungssysteme auf die Sojabohnenerträge im ökologischen Landbau in Luxemburg

Im ökologischen Sojaanbau in Luxemburg wurden fünf Beikrautregulierungsmethoden sowie zwei Kotrollen getestet. Hacken erzielte generell höhere Erträge als Striegeln. Eine konsequente Feldbewirtschaftung während der Fruchtfolge ist der Schlüsselfaktor zur Maximierung des Sojabohnenertrags

Einfluss der Witterungsbedingungen auf den Ertrag von in Luxemburg typischen Körnerleguminosen

Meteorologische Parameter wurden mit Ertragsparametern für Körnerleguminosen wie Ackerbohne, Erbse und Sojabohne gängiger Sorten in Luxemburg verglichen. Die Ergebnisse zeigen signifikante Korrelationen zwischen Niederschlag, relativer Luftfeuchtigkeit, Temperatur und Ertragsparametern

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment

The three Rs of river ecosystem resilience : Resources, recruitment, and refugia

This review article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived VersionResilience in river ecosystems requires that organisms must persist in the face of highly dynamic hydrological and geomorphological variations. Disturbance events such as floods and droughts are postulated to shape life history traits that support resilience, but river management and conservation would benefit from greater understanding of the emergent effects in communities of river organisms. We unify current knowledge of taxonomic-, phylogenetic-, and trait-based aspects of river communities that might aid the identification and quantification of resilience mechanisms. Temporal variations in river productivity, physical connectivity, and environmental heterogeneity resulting from floods and droughts are highlighted as key characteristics that promote resilience in these dynamic ecosystems. Three community-wide mechanisms that underlie resilience are (a) partitioning (competition/facilitation) of dynamically varying resources, (b) dispersal, recolonization, and recruitment promoted by connectivity, and (c) functional redundancy in communities promoted by resource heterogeneity and refugia. Along with taxonomic and phylogenetic identity, biological traits related to feeding specialization, dispersal ability, and habitat specialization mediate organism responses to disturbance. Measures of these factors might also enable assessment of the relative contributions of different mechanisms to community resilience. Interactions between abiotic drivers and biotic aspects of resource use, dispersal, and persistence have clear implications for river conservation and management. To support these management needs, we propose a set of taxonomic, phylogenetic, and life-history trait metrics that might be used to measure resilience mechanisms. By identifying such indicators, our proposed framework can enable targeted management strategies to adapt river ecosystems to global change

Impact of ENSO longitudinal position on teleconnections to the NAO

While significant improvements have been made in understanding how the El Niño–Southern Oscillation (ENSO) impacts both North American and Asian climate, its relationship with the North Atlantic Oscillation (NAO) remains less clear. Observations indicate that ENSO exhibits a highly complex relationship with the NAO-associated atmospheric circulation. One critical contribution to this ambiguous ENSO/NAO relationship originates from ENSO’s diversity in its spatial structure. In general, both eastern (EP) and central Pacific (CP) El Niño events tend to be accompanied by a negative NAO-like atmospheric response. However, for two different types of La Niña the NAO response is almost opposite. Thus, the NAO responses for the CP ENSO are mostly linear, while nonlinear NAO responses dominate for the EP ENSO. These contrasting extra-tropical atmospheric responses are mainly attributed to nonlinear air-sea interactions in the tropical eastern Pacific. The local atmospheric response to the CP ENSO sea surface temperature (SST) anomalies is highly linear since the air-sea action center is located within the Pacific warm pool, characterized by relatively high climatological SSTs. In contrast, the EP ENSO SST anomalies are located in an area of relatively low climatological SSTs in the eastern equatorial Pacific. Here only sufficiently high positive SST anomalies during EP El Niño events are able to overcome the SST threshold for deep convection, while hardly any anomalous convection is associated with EP La Niña SSTs that are below this threshold. This ENSO/NAO relationship has important implications for NAO seasonal prediction and places a higher requirement on models in reproducing the full diversity of ENSO