A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation

AIMS AND OBJECTIVES: The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. BACKGROUND: Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. DESIGN: A pre-post design was used. METHODS: The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. RESULTS: From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. CONCLUSION: The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. RELEVANCE TO CLINICAL PRACTICE: HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Influence of backpressure during ECAP on the monotonic and cyclic deformation behavior of AA5754 and Cu99.5

Ultrafine-grained (UFG) metals produced by equal channel angular pressing (ECAP) exhibit outstanding mechanical properties. They show high strength under monotonic loading as well as strongly enhanced fatigue lives in the Wöhler S-N-plot compared to their coarse grained (CG) counterparts. It could be shown that the fatigue lives can be significantly enhanced further by applying backpressure during ECAP. Besides the positive effect of backpressure on the processability of hard to deform materials via ECAP, the hydrostatic stress induced by backpressure also influences the mechanical properties under monotonic and cyclic loading. Therefore the influence of backpressure on ECAPed Cu99.5 and on the ECAPed aluminum alloy AA5754 was investigated. It is shown that backpressure has no effect on the hardness and grain size in Cu99.5 but changes the grain boundary misorientation to higher fractions of low angle grain boundaries. Also the temperature dependency of the yield strength as well as the hardening behavior under monotonic compression is affected. The cyclic deformation behavior of Cu99.5 is not strongly influenced by backpressure, but the mean stress level changes drastically. The fatigue life increases with the application of backpressure at low plastic amplitudes due to a change in the crack initiation and propagation. Aim of this work is the investigation of the influence of backpressure during equal channel angular pressing (ECAP) on the mechanical properties under monotonic and cyclic loading. Therefore we performed hardness measurements, compression, and fatigue tests on ECAPed Cu99.5 and AA5754. The results are discussed in terms of microstructure and relevant deformation and damage mechanisms.

Cocaine-specific neuroplasticity in the ventral striatum network is linked to delay discounting and drug relapse

AIMS: To contrast functional connectivity on ventral and dorsal striatum networks in cocaine dependence relative to pathological gambling, via a resting-state functional connectivity approach; and to determine the association between cocaine dependence-related neuroadaptations indexed by functional connectivity and impulsivity, compulsivity and drug relapse. DESIGN: Cross-sectional study of 20 individuals with cocaine dependence (CD), 19 individuals with pathological gambling (PG) and 21 healthy controls (HC), and a prospective cohort study of 20 CD followed-up for 12 weeks to measure drug relapse. SETTING AND PARTICIPANTS: CD and PG were recruited through consecutive admissions to a public clinic specialized in substance addiction treatment (Centro Provincial de Drogodependencias) and a public clinic specialized in gambling treatment (AGRAJER), respectively; HC were recruited through community advertisement in the same area in Granada (Spain). MEASUREMENTS: Seed-based functional connectivity in the ventral striatum (ventral caudate and ventral putamen) and dorsal striatum (dorsal caudate and dorsal putamen), the Kirby delay-discounting questionnaire, the reversal-learning task and a dichotomous measure of cocaine relapse indicated with self-report and urine tests. FINDINGS: CD relative to PG exhibit enhanced connectivity between the ventral caudate seed and subgenual anterior cingulate cortex, the ventral putamen seed and dorsomedial pre-frontal cortex and the dorsal putamen seed and insula (P≤0.001, kE=108). Connectivity between the ventral caudate seed and subgenual anterior cingulate cortex is associated with steeper delay discounting (P≤0.001, kE=108) and cocaine relapse (P≤0.005, kE=34). CONCLUSIONS: Cocaine dependence-related neuroadaptations in the ventral striatum of the brain network are associated with increased impulsivity and higher rate of cocaine relapse.

Output and labor productivity in organized manufacturing: a panel cointegration analysis for India

One of the policy puzzles faced in India during the last two and half decades has been the weak association between output and labor markets, particularly in the manufacturing sector. In this research, we investigate the long-run relationship between output, labor productivity and real wages in the case of organized manufacturing. We adjust the measure of labor productivity incorporating bottlenecks, such as lack of infrastructure, access to external finance, and labor regulations, which all may influence labor market outcomes. Using panel data from seventeen manufacturing industries, we establish long-run dynamics for the output-labor productivity-real wages series over a period of nearly three decades. We employ recently developed panel unit root and cointegration tests for cross-sectional dependence to incorporate heterogeneity across industries. Long-run elasticities are generally found to be low for labor productivity compared to real wages due to the changes in manufacturing output. There are variations across industries within the manufacturing sector for the effects of the labor market on manufacturing output. In some industries, lower wages are associated with higher output, and the reason for the positive relationship in other industries could be due to workers' bargaining power.

Personality and individual differences in plasticity

In the last few years, investigators have documented individual differences in many different types of behavioral plasticity. Of particular interest are individual differences in the temporal plasticity of personality traits over extended (ontogenetic) periods of time, because of the relevance of these data to models of behavioral development. We discuss recent empirical studies of the temporal consistency of personality over ontogeny, and models that make contrasting predictions about individual differences in the developmental trajectories of behavioral traits. In addition, we consider recent advances in studies of relationships between personality traits and particular types of behavioral plasticity, including statistical methods which facilitate analyses of relationships between personality traits, contextual plasticity, temporal plasticity and intraindividual variability, and empirical tests of predicted relationships between personality traits and other types of behavioral plasticity (flexibility, learning rates). As the field of animal personality and behavioral plasticity moves from a largely descriptive to a predictive phase, we suggest that there is ample room for empirical tests of recent models that predict individual differences in behavioral developmental trajectories, and for the development of new formal models that make strong predictions about relationships between personality traits and specific types of behavioral plasticity.