This study explores how Confucianism affects suicide rates by gender. Data for the study come from the World Health Organization document "Suicide Worldwide in 2019", which provides frequency and ...gender ratios for suicide rates in 183 member countries. One-way ANOVA and multiple linear regression analysis were used to examine potential differences in suicide rates and male to female ratio of suicides. Independent variables include region, income level, culture, and Confucian values that may be related to suicide. Suicide rates for Confucian countries do not show significant differences from European countries. However, these countries have lower suicide gender ratios.
To determine if signals generated by a new sleep monitor (Prodigy) are comparable to signals generated during in-laboratory polysomnography (PSG).
Fifty-nine patients with various sleep disorders (25 ...with moderate/severe sleep apnea) were studied. Full PSG was performed using standard acquisition systems. Prodigy was attached to the forehead with four disposable snap electrodes. Four additional electrodes were attached to monitor eye movements and muscle activity, and to serve as reference (mastoid). One frontal EEG signal was outputted in real time from the monitor and stored in the PSG record along with the other PSG signals. PSG was scored for sleep variables manually, and monitor records were scored by a validated automatic system (MSS) (MSS-Prodigy). MSS-Prodigy was briefly edited following suggestions of an Editing Helper feature of MSS.
Technical failures resulted in one study being unusable and another with data for only 3 hours. Prodigy EEG signal stored in the PSG record was visually indistinguishable from the PSG-derived EEG signals. Important differences between manual scores and unedited MSS-Prodigy were seen in a few patients in some sleep variables (notably onset latencies and REM time). Editing Helper issued 2.1 ± 0.8 suggestions/file. Only these suggestions were pursued during editing. Intraclass correlation coefficients for manual vs. edited MSS-Prodigy were > 0.83 for all sleep variables except for stages N1 and N3 (0.57 and 0.58).
When scored with MSS, and with only very minor editing, the monitor's results show excellent agreement with manual scoring of polysomnography data, even in patients with severe sleep disorders.
Paleontological monitoring at Badlands National Park is extremely complex. The monitoring program has steadily evolved from its formalization in 1994 with the hiring of the first park paleontologist. ...Changing regulations, increases in protections for paleontological resources, positive interdivisional communication, sympathetic leadership, and the hiring of a full-time monitor have allowed staff to move from being purely reactive to taking an active role in planning park projects. This entails commenting on compliance through the National Park Service's Planning, Environment & Public Comment portal, conducting pre-construction surveys, attending pre-construction meetings, providing resource training for construction personnel, consulting with the Federal Highway Administration as subject-matter experts, and acting as the contracting officer's representative on select projects. The monitoring program strives to hire qualified personnel according to best practice guidelines and provides additional training in documentation, fossil identification, field methods, and effective communication prior to allowing monitors to be onsite. The monitoring program works to add value to projects such as GIS database management for park utilities, assisting with project planning, and acting as additional spotters for issues on the ground during construction. Additionally, monitors are frequently tasked with assisting in law enforcement cases and any other situation in which their skill sets can be brought to bear. The future of paleontological monitoring at Badlands National Park will continue to see the integration of technology, expertise, and communication to ensure that all projects are completed successfully, and resources are handled with the care and respect the public expects of the National Park Service.
Automatic scoring of polysomnography records offers many advantages, but excessive editing time seriously limits its use.
To identify reasons for excessive editing time, and the clinical utility of ...such editing, and to develop an approach to optimize the editing process.
Forty-two polysomnograms scored manually were scored months later by an automatic system (Michele Sleep Scoring). Results were edited by the technologist who scored them initially. Editing actions and time were documented. An Editing Helper algorithm was developed on the basis of these results, and its effectiveness was tested in 60 new records.
Technologists performed 253 ± 110 actions, consuming 54.5 ± 26.3 minutes, per file. Of the edits, 33% were either subsequently reversed or not considered in the clinical summary. The electroencephalography pattern in 67% of epochs changed from awake to non-REM sleep, and vice versa, represented neither stable wakefulness nor sleep so that assigning a precise stage was arbitrary. Many opposing changes occurred. Ultimately the impact of editing on summary results was limited. In the second set, the Editing Helper algorithm reduced editing time from 59 ± 26 to 6 ± 7 minutes. Average (±SD) intraclass correlation coefficients for 15 reported variables were 0.77 ± 0.14 for manual versus unedited automatic, 0.89 ± 0.09 for manual versus fully edited automatic, and 0.87 ± 0.08 for manual versus automatic edited according to the Editing Helper's suggestions only, and there was no difference between the last two average intraclass correlation coefficients.
Editing time does not reflect unreliable scoring. Comprehensive editing of a well-validated automatic scoring system is highly inefficient. Editing can be substantially optimized.
Mindfulness is a mental state attained through focusing awareness on the present with calm acceptance of thoughts, feelings, and bodily sensations. This study evaluated impact of mindfulness ...activities on well-being of pharmacy and other healthcare students.
Research participants completed pre- and post-intervention questionnaires evaluating multi-modal mindfulness interventions. Due to the pandemic, sessions led by a certified mindfulness instructor were offered live online and recorded, supplemented by a well-being mobile app and reflective discussion component. Four composite scales were administered to participants. The Brief Resilient Coping Scale (BRCS), Five Facet Mindfulness Questionnaire (FFMQ-15), Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and Depression Anxiety Stress Scales (DASS-21) inventories measured resilient coping skills, awareness, and psychological symptoms, including stress, depression, and anxiety. Exploratory factor analysis and Cronbach's alpha were used to determine scale reliability and validity.
Thirty-six participants completed both pre- and post-intervention questionnaires (n = 36). Significant improvement was found in well-being for BRCS, FFMQ-15, and WEMWBS measures (P < .05). Change in DASS-21 was not significant (P = .19). Mobile app use enhanced foundational mindfulness skills. Awareness, connection, and coping themes were identified from written comments.
Evaluation of this multi-modal interprofessional intervention provides further evidence of benefits of mindfulness for pharmacy and other healthcare students. The mobile app and mindful movement with reflection improved all attributes measured by the composite scales. Further research may explore alternative multi-modal mindfulness interventions and incorporation into healthcare education curricula. Interprofessional collaboration is encouraged among faculty to enhance mindfulness while connecting healthcare professionals.
Aims
To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs’ identities ...and how they both enable and constrain their roles.
Background
Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers.
Design
A qualitative discourse analysis using Gee's Tools of Inquiry.
Method
Data were collected between April 2019 and January 2020 through seven in‐depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals.
Findings
Five key discourses emerged. Language‐in‐use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs’ identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other.
Conclusion
This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs’ identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals’ roles.
Impact
By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role.
Handbook of SAS DATA Step Programming Meng, Xiangxiang; Thompson, Wayne
Journal of statistical software,
2014, Volume:
56, Issue:
Book Review 1
Journal Article
Healthcare systems are becoming increasingly complex. Systems thinking can help us to understand this complexity and how to apply that understanding to design and evaluate interventions that improve ...health outcomes. With the current emphasis on developing advanced nursing practice, it is timely to examine systemic processes that characterize ANP systems and their interactions with wider healthcare systems, and how these processes enable and constrain the role.
To make explicit the systemic processes that characterize the Advanced Nurse Practitioner (ANP) system and how they enable and constrain the role.
An interpretive descriptive study.
The study was conducted in a large Hospital Group, consisting of eleven acute hospitals, within the Irish Healthcare System.
Twenty nine participants, including ANPs, nurses, nurse managers, medics and allied health professionals, participated in the study.
Data were collected through seven in-depth interviews and four focus groups. Data were analyzed using the Organic Systems Framework (OSF), where attention was on language indicative of the processes of individuation, integration, differentiation and homogenization.
Participants emphasize how ANP systems exert power by individuating and differentiating; however, restrictive regulations and medical control constrain this power. Integration and homogenization are expressed as ANPs encourage and engage in collaborative practice towards common purposes. When hierarchical structures and professional self-interest dominate, however, these processes are submerged, resulting in unbalanced systems.
ANP systems realize their power through increased autonomy by individuating and differentiating. Hierarchical structures positioning ANPs in subservient roles should be challenged. Processes of integration and homogenization are expressed in collaborative practices. We recommend that ANPs realize and articulate the value and diversity that they bring to health systems to strengthen their contribution to them.
Lack of awareness of the systemic processes that enable and constrain the ANP role affects the role's potential contribution to the healthcare system. Systems thinking and employing the OSF as an analysis framework can help us to understand these processes and their implications, and how to apply that understanding to design and evaluate interventions that improve health outcomes.
Aims and objectives
To explore how language works to enable and constrain the role of the advanced nurse practitioner (ANP) in the health system.
Background
Nurses and doctors are produced within ...historically established disciplinary boundaries. These boundaries are becoming more porous, offering the possibility of a more liberated identity for ANPs that will allow them to reach their full potential. Current uncertainty and confusion about ANPs’ identity result in their role being underutilised.
Design
A critical discourse analysis design was used to explore participants’ language‐in‐use. Findings are reported according to the COREQ research checklist.
Method
Data were collected through seven in‐depth interviews and four focus groups and analysed using Gee’s (2010) Identity Building Tool. Participants included ANPs, nurses (including nurse managers), doctors and allied healthcare professionals.
Results
Four discourses were revealed. Participants’ language‐in‐use worked to privilege the ANP’s uniquely holistic identity. However, this aspect is also associated with a controlled identity, predominantly constrained by medics and restricted from advancing. The third discourse, the medicalised identity builds an identity that positions ANPs as medical replacements who are assigned trivial medical tasks. The final discourse constructs an independent powerful identity for the ANP that is influential and autonomous.
Conclusions
Circulating discourses and conversations can influence and shape the construction of the ANP identity. Healthcare professionals need to identify and counter discourses and conversations that construct ANPs’ ways of knowing and knowledge as inferior and their role as subservient. Otherwise, ANPs’ identity will continue to be controlled and their advancement restricted.
Relevance to clinical practice
Confusion concerning the role and identity of the ANP can limit their contribution to the healthcare system. Healthcare professionals need to be aware of how language‐in‐use can prevent the role from developing and reaching its full potential in enhancing healthcare provision and delivery. Reporting follows the COREQ criteria.
ABSTRACT
The habitat of the critically endangered Devils Hole Pupfish, Cyprinodon diabolis is marked by constant high temperatures and low oxygen availability. In order to explore the effects of ...these conditions on development and recruitment of eggs in Devils Hole, we tested the effects of two ecologically relevant temperatures on the development, hatch success, and oxygen consumption of eggs from a refuge population of pupfish derived from C. diabolis and eggs from its close sister species, Cyprinodon nevadensis mionectes. We developed a simple method to measure oxygen consumption in a single egg. Parent acclimation temperature, rather than incubation temperature, was the most important factor influencing hatch success. Eggs incubated at 33°C hatched more quickly compared to those incubated at 28°C. Despite this accelerated development, larvae from both temperatures were of similar size at hatch. Unexpectedly, eggs incubated at 33°C experience lower than expected oxygen consumption rates compared to those incubated at 28°C. Oxygen consumption rates would be limited at PO2 values that are much higher than environmental oxygen tensions. Oxygen consumption increased dramatically upon hatch, indicating that low oxygen conditions such as those present in Devils Hole may limit developing eggs.
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