Test of a smock system on CPR primary emergency measures and medical errors during simulated emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on: 1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

Test of a Smock System on CPR Primary Emergency Measures and Medical Errors During Simulated Emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

An analysis of the on-time graduation rate in the two-year program at National Taipei Institute of Technology in Taiwan

Taiwan's technical vocational educational system includes three levels: (1) institutes of technology (two and four year programs), (2) junior colleges (two, three and five year programs), and (3) senior vocational schools. Two-year junior colleges enroll their students through two channels: (1) based on results of the Particular Screening Entrance Examination (PSEE), (2) based on the Joint College Entrance Examination (JCEE). The PSEE has two categories: Category I includes on-time graduates with excellent performance, which means that they are within the top ten of their classes; Category II students include award-winning students in talent contests who have achieved a minimum grade point average of 75%. The JCEE is a regular entrance examination given to any senior vocation school graduate.^ Basic courses have a great impact on the students' academic performance. The purpose of the study was to focus on the effectiveness of teaching mathematics in two-year junior colleges and to analyze and correlate the results of two-year junior college students' performance in calculus and on-time graduation. The target group consisted of 521 students enrolled at National Taipei Institute of Technology in 1993.^ Calculus is a very important course for engineering majors in two-year junior colleges and has a great impact on the students' academic performance. This retrospective study showed that there was a correlation between students' performance in calculus and on-time graduation after two years of study.^ The conclusions of the study urge the Ministry of Education to reform two-year junior college curriculum standards to emphasize basic rudimentary courses. It is recommended that engineering majors receive three hours of calculus per week as the current requirement of only two hours per week is inadequate. The future job market will require a technologically advanced labor force that can be trained in a higher education system. More channels of higher education for two-year junior college graduates should be made available for those wishing to pursue bachelor degrees. Additional work in calculus will not only enhance the opportunities for two-year junior college graduates to continue their pursuit of an advanced academic degree, but also serve them well as they seek career advancement. ^

A comparative analysis of self-determined evaluations of work performance and support needs by adults with mental retardation in supported work and in sheltered workshop environments

The purpose of this study was to determine if there was a difference in the self-determined evaluations of work performance and support needs by adults with mental retardation in supported employment and in sheltered workshop environments. The instrument, Job Observation and Behavior Scale: Opportunity for Self-Determination (JOBS: OSD; Brady, Rosenberg, & Frain, 2006), was administered to 38 adults with mental retardation from sheltered workshops and 32 adults with mental retardation from supported employment environments. Cross-tabulations with Chi-square tests and independent samples t-tests were conducted to evaluate differences between the two groups, sheltered workshop and supported work. Two Multivariate Analyses of Variance (MANOVAs) were conducted to determine the effect of work environment on Quality of Performance (QP) and Types of Support (TS) test scores and their subscales. ^ This study found that there were significant differences between the groups on the QP Behavior and Job Duties subscales. The sheltered workshop group perceived themselves as performing significantly better on job duties than the supported work group. Conversely, the supported work group perceived themselves to have better behavior than the sheltered workshop group. However, there were no significant differences between groups in their perception of support needs for the three subscales. ^ The findings imply that work environment affects the self-determined evaluations of work performance by adults with mental retardation. Recommendations for further study include (a) detailing the characteristics of supported work and sheltered workshops that support and/or discourage self-determined behaviors, (b) exploring the behavior of adults with mental retardation in sheltered workshops and supported work environments, and (c) analysis of the support needs for and understanding of them by adults with mental retardation in sheltered workshops and in supported work environments. ^

Improving novice analyst performance in modeling the sequence diagram in systems analysis: A cognitive complexity approach

The Unified Modeling Language (UML) has quickly become the industry standard for object-oriented software development. It is being widely used in organizations and institutions around the world. However, UML is often found to be too complex for novice systems analysts. Although prior research has identified difficulties novice analysts encounter in learning UML, no viable solution has been proposed to address these difficulties. Sequence-diagram modeling, in particular, has largely been overlooked. The sequence diagram models the behavioral aspects of an object-oriented software system in terms of interactions among its building blocks, i.e. objects and classes. It is one of the most commonly-used UML diagrams in practice. However, there has been little research on sequence-diagram modeling. The current literature scarcely provides effective guidelines for developing a sequence diagram. Such guidelines will be greatly beneficial to novice analysts who, unlike experienced systems analysts, do not possess relevant prior experience to easily learn how to develop a sequence diagram. There is the need for an effective sequence-diagram modeling technique for novices. This dissertation reports a research study that identified novice difficulties in modeling a sequence diagram and proposed a technique called CHOP (CHunking, Ordering, Patterning), which was designed to reduce the cognitive load by addressing the cognitive complexity of sequence-diagram modeling. The CHOP technique was evaluated in a controlled experiment against a technique recommended in a well-known textbook, which was found to be representative of approaches provided in many textbooks as well as practitioner literatures. The results indicated that novice analysts were able to perform better using the CHOP technique. This outcome seems have been enabled by pattern-based heuristics provided by the technique. Meanwhile, novice analysts rated the CHOP technique more useful although not significantly easier to use than the control technique. The study established that the CHOP technique is an effective sequence-diagram modeling technique for novice analysts.

The development of optimized high performance liquid chromatography systems for the analysis of improvised explosives

Existing instrumental techniques must be adaptable to the analysis of novel explosives if science is to keep up with the practices of terrorists and criminals. The focus of this work has been the development of analytical techniques for the analysis of two types of novel explosives: ascorbic acid-based propellants, and improvised mixtures of concentrated hydrogen peroxide/fuel. In recent years, the use of these explosives in improvised explosive devices (IEDs) has increased. It is therefore important to develop methods which permit the identification of the nature of the original explosive from post-blast residues. Ascorbic acid-based propellants are low explosives which employ an ascorbic acid fuel source with a nitrate/perchlorate oxidizer. A method which utilized ion chromatography with indirect photometric detection was optimized for the analysis of intact propellants. Post-burn and post-blast residues if these propellants were analyzed. It was determined that the ascorbic acid fuel and nitrate oxidizer could be detected in intact propellants, as well as in the post-burn and post-blast residues. Degradation products of the nitrate and perchlorate oxidizers were also detected. With a quadrupole time-of-flight mass spectrometer (QToFMS), exact mass measurements are possible. When an HPLC instrument is coupled to a QToFMS, the combination of retention time with accurate mass measurements, mass spectral fragmentation information, and isotopic abundance patterns allows for the unequivocal identification of a target analyte. An optimized HPLC-ESI-QToFMS method was applied to the analysis of ascorbic acid-based propellants. Exact mass measurements were collected for the fuel and oxidizer anions, and their degradation products. Ascorbic acid was detected in the intact samples and half of the propellants subjected to open burning; the intact fuel molecule was not detected in any of the post-blast residue. Two methods were optimized for the analysis of trace levels of hydrogen peroxide: HPLC with fluorescence detection (HPLC-FD), and HPLC with electrochemical detection (HPLC-ED). Both techniques were extremely selective for hydrogen peroxide. Both methods were applied to the analysis of post-blast debris from improvised mixtures of concentrated hydrogen peroxide/fuel; hydrogen peroxide was detected on variety of substrates. Hydrogen peroxide was detected in the post-blast residues of the improvised explosives TATP and HMTD.

Does management capacity increase organizational performance? An empirical analysis of public housing agencies

Since the 1990s, scholars have paid special attention to public management’s role in theory and research under the assumption that effective management is one of the primary means for achieving superior performance. To some extent, this was influenced by popular business writings of the 1980s as well as the reinventing literature of the 1990s. A number of case studies but limited quantitative research papers have been published showing that management matters in the performance of public organizations. ^ My study examined whether or not management capacity increased organizational performance using quantitative techniques. The specific research problem analyzed was whether significant differences existed between high and average performing public housing agencies on select criteria identified in the Government Performance Project (GPP) management capacity model, and whether this model could predict outcome performance measures in a statistically significant manner, while controlling for exogenous influences. My model included two of four GPP management subsystems (human resources and information technology), integration and alignment of subsystems, and an overall managing for results framework. It also included environmental and client control variables that were hypothesized to affect performance independent of management action. ^ Descriptive results of survey responses showed high performing agencies with better scores on most high performance dimensions of individual criteria, suggesting support for the model; however, quantitative analysis found limited statistically significant differences between high and average performers and limited predictive power of the model. My analysis led to the following major conclusions: past performance was the strongest predictor of present performance; high unionization hurt performance; and budget related criterion mattered more for high performance than other model factors. As to the specific research question, management capacity may be necessary but it is not sufficient to increase performance. ^ The research suggested managers may benefit by implementing best practices identified through the GPP model. The usefulness of the model could be improved by adding direct service delivery to the model, which may also improve its predictive power. Finally, there are abundant tested concepts and tools designed to improve system performance that are available for practitioners designed to improve management subsystem support of direct service delivery.^

An Analysis of Stock Market Performance:The Dow Jones Industrial Average and the Three Top Performing Lodging Firma: 1982-1988

In their dialogue - An Analysis of Stock Market Performance: The Dow Jones Industrial Average and the Three Top Performing Lodging Firms 1982 – 1988 - by N. H. Ringstrom, Professor and Elisa S. Moncarz, Associate Professor, School of Hospitality Management at Florida International University, Professors Ringstrom and Moncarz state at the outset: “An interesting comparison can be made between the Dow Jones lndustrial Average and the three top performing, publicly held lodging firms which had $100 million or more in annual lodging revenues. The authors provide that analytical comparison with Prime Motor Inns Inc., the Marriott Corporation, and Hilton Hotels Corporation.” “Based on a criterion of size, only those with $100 million in annual lodging revenues or more resulted in the inclusion of the following six major hotel firms: Prime Motor Inns, Inc., Marriott Corporation, Hilton Hotels Corporation, Ramada Inc., Holiday Corporation and La Quinta Motor Inns, Inc.,” say Professors Ringstrom and Moncarz in framing this discussion with its underpinnings in the years 1982 to 1988. The article looks at each company’s fiscal and Dow Jones performance for the years in question, and presents a detailed analysis of said performance. Graphic analysis is included. It helps to have a fairly vigorous knowledge of stock market and fiscal examination criteria to digest this material. The Ringstrom and Moncarz analysis of Prime Motor Inns Incorporated occupies the first 7 pages of this article in and of itself. Marriot Corporation also occupies a prominent position in this discussion. “Marriott, a giant in the hospitality industry, is huge and continuing to grow. Its 1987 sales were more than $6.5 billion, and its employees numbered over 200,000 individuals, which place Marriott among the 10 largest private employers in the country,” Ringstrom and Moncarz parse Marriott’s influence as a significant financial player. “The firm has a fantastic history of growth over the past 60 years, starting in May 1927 with a nine-seat A & W Root Beer stand in Washington, D.C.,” offer the authors in initialing Marriot’s portion of the discussion with a brief history lesson. The Marriot firm was officially incorporated as Hot Shoppes Inc. in 1929. As the thesis statement for the discussion suggests the performance of these huge, hospitality giants is compared and contrasted directly to the Dow Jones Industrial Average performance. Reasons and empirical data are offered by the authors to explain the distinctions. It would be difficult to explain those distinctions without delving deeply into corporate financial history and the authors willingly do so in an effort to help you understand the growth, as well as some of the setbacks of these hospitality based juggernauts. Ringstrom and Moncarz conclude the article with an extensive overview and analysis of the Hilton Hotels Corporation performance for the period outlined. It may well be the most fiscally dynamic of the firms presented for your perusal. “It is interesting to note that Hilton Hotels Corporation maintained a very strong financial position with relatively little debt during the years 1982-1988…the highest among all companies in the study,” the authors paint.

Does Financial Performance Depend on Hotel Size? Analysis of the Financial Profile of the U.S. Lodging Industry

This research presents a financial profile of the U.S. Lodging Industry based on an analysis of 2,091 financial statements (fiscal year 2011) for individual hotels ranging in asset size of $500 thousand to $250 million. The study analyzes summary results of the financial position and profitability of hotels based on a common size analysis of Balance Sheets and Income Statements. Furthermore, the study analyzes 10 key performance benchmarks as measured by Liquidity, Solvency and Operating Ratios. The results of the study show a divergence in the hotel industry’s financial performance based on the size of the hotel and by upper, median and lower quartiles of the study sample.

Importance-Performance Analysis of Guest Entertainment Technology Amenities in the Lodging Industry

An assessment of how hotel guests view in-room entertainment-technology amenities was conducted to compare the importance of these technologies to how they performed. In-room entertainment technology continues to evolve in the hotel industry. However, given the multitude of entertainment products available in the marketplace today, hoteliers have little understanding of guests’ expectations and of which in-room entertainment-technology amenities will drive guest satisfaction and increase loyalty to the hotel brand. Given that technology is integral to a hotel stay, this study seeks to evaluate the importance and performance of in-room entertainment-technology amenities. Findings indicate that free-to-guest television (FTG TV) and high-speed Internet access were the two most important inroom entertainment-technology amenities when it comes to the selection of a hotel for both leisure and business travelers. The Importance/Satisfaction Matrix presented in the current study showed that many of the in-room entertainment-technology amenities are currently a low priority for guests. Keywords: importance-performance analysis, hotel, in-room entertainment technologies

The employee satisfaction -performance link: A unit -level analysis

In this dissertation, I present an integrated model of organizational performance. Most prior research has relied extensively on testing individual linkages, often with cross-sectional data. In this dissertation, longitudinal unit-level data from 559 restaurants, collected over a one-year period, were used to test the proposed model. The model was hypothesized to begin with employee satisfaction as a key antecedent that would ultimately lead to improved financial performance. Several variables including turnover, efficiency, and guest satisfaction are proposed as mediators of the satisfaction-performance relationship. The current findings replicate and extend past research using individual-level data. The overall model adequately explained the data, but was significantly improved with an additional link from employee satisfaction to efficiency, which was not originally hypothesized. Management turnover was a strong predictor of hourly level team turnover, and both were significant predictors of efficiency. Full findings for each hypothesis are presented and practical organizational implications are given. Limitations and recommendations for future research are provided. ^

The relationship of instructor technical literacy to the academic performance of students in career academies

Career Academy instructors' technical literacy is vital to the academic success of students. This nonexperimental ex post facto study examined the relationships between the level of technical literacy of instructors in career academies and student academic performance. It was also undertaken to explore the relationship between the pedagogical training of instructors and the academic performance of students. ^ Out of a heterogeneous population of 564 teachers in six targeted schools, 136 teachers (26.0 %) responded to an online survey. The survey was designed to gather demographic and teaching experience data. Each demographic item was linked by researchers to teachers' technology use in the classroom. Student achievement was measured by student learning gains as assessed by the reading section of the FCAT from the previous to the present school year. ^ Linear and hierarchical regressions were conducted to examine the research questions. To clarify the possibility of teacher gender and teacher race/ethnic group differences by research variable, a series of one-way ANOVAs were conducted. As revealed by the ANOVA results, there were not statistically significant group differences in any of the research variables by teacher gender or teacher race/ethnicity. Greater student learning gains were associated with greater teacher technical expertise integrating computers and technology into the classroom, even after controlling for teacher attitude towards computers. Neither teacher attitude toward technology integration nor years of experience in integrating computers into the curriculum significantly predicted student learning gains in the regression models. ^ Implications for HRD theory, research, and practice suggest that identifying teacher levels of technical literacy may help improve student academic performance by facilitating professional development strategies and new parameters for defining highly qualified instructors with 21st century skills. District professional development programs can benefit by increasing their offerings to include more computer and information communication technology courses. Teacher preparation programs can benefit by including technical literacy as part of their curriculum. State certification requirements could be expanded to include formal surveys to assess teacher use of technology.^

Method development for the analysis of smokeless powders and organic gunshot residue by ultra performance liquid chromatography with tandem mass spectrometry

The goal of this project was to develop a rapid separation and detection method for analyzing organic compounds in smokeless powders and then test its applicability on gunshot residue (GSR) samples. In this project, a total of 20 common smokeless powder additives and their decomposition products were separated by ultra performance liquid chromatography (UPLC) and confirmed by tandem mass spectrometry (MS/MS) using multiple reaction monitoring mode (MRM). Some of the targeted compounds included diphenylamines, centralites, nitrotoluenes, nitroglycerin, and various phthalates. The compounds were ionized in the MS source using simultaneous positive and negative electrospray ionization (ESI) with negative atmospheric pressure chemical ionization (APCI) in order to detect all compounds in a single analysis. The developed UPLC/MS/MS method was applied to commercially available smokeless powders and gunshot residue samples recovered from the hands of shooters, spent cartridges, and smokeless powder retrieved from unfired cartridges. Distinct compositions were identified for smokeless powders from different manufacturers and from separate manufacturing lots. The procedure also produced specific chemical profiles when tested on gunshot residues from different manufacturers. Overall, this thesis represents the development of a rapid and reproducible procedure capable of simultaneously detecting the widest possible range of components present in organic gunshot residue.^

The relationship between cognitive ability, the big five, task and contextual performance: a meta-analysis

For years, researchers and human resources specialists have been searching for predictors of performance as well as for relevant performance dimensions (Barrick & Mount, 1991; Borman & Motowidlo, 1993; Campbell, 1990; Viswesvaran et al., 1996). In 1993, Borman and Motowidlo provided a framework by which traditional predictors such as cognitive ability and the Big Five personality factors predicted two different facets of performance: 1) task performance and 2) contextual performance. A meta-analysis was conducted to assess the validity of this model as well as that of other modified models. The relationships between predictors such as cognitive ability and personality variables and the two outcome variables were assessed. It was determined that even though the two facets of performance may be conceptually different, empirically they overlapped substantially (p= .75). Finally, results show that there is some evidence for cognitive ability as a predictor of both task and contextual performance and conscientiousness as a predictor of both task and contextual performance. The possible mediation of predictor-- criterion relationships was also assessed. The relationship between cognitive ability and contextual performance vanished when task performance was controlled.

Improving Novice Analyst Performance in Modeling the Sequence Diagram in Systems Analysis: A Cognitive Complexity Approach

The Unified Modeling Language (UML) has quickly become the industry standard for object-oriented software development. It is being widely used in organizations and institutions around the world. However, UML is often found to be too complex for novice systems analysts. Although prior research has identified difficulties novice analysts encounter in learning UML, no viable solution has been proposed to address these difficulties. Sequence-diagram modeling, in particular, has largely been overlooked. The sequence diagram models the behavioral aspects of an object-oriented software system in terms of interactions among its building blocks, i.e. objects and classes. It is one of the most commonly-used UML diagrams in practice. However, there has been little research on sequence-diagram modeling. The current literature scarcely provides effective guidelines for developing a sequence diagram. Such guidelines will be greatly beneficial to novice analysts who, unlike experienced systems analysts, do not possess relevant prior experience to easily learn how to develop a sequence diagram. There is the need for an effective sequence-diagram modeling technique for novices. This dissertation reports a research study that identified novice difficulties in modeling a sequence diagram and proposed a technique called CHOP (CHunking, Ordering, Patterning), which was designed to reduce the cognitive load by addressing the cognitive complexity of sequence-diagram modeling. The CHOP technique was evaluated in a controlled experiment against a technique recommended in a well-known textbook, which was found to be representative of approaches provided in many textbooks as well as practitioner literatures. The results indicated that novice analysts were able to perform better using the CHOP technique. This outcome seems have been enabled by pattern-based heuristics provided by the technique. Meanwhile, novice analysts rated the CHOP technique more useful although not significantly easier to use than the control technique. The study established that the CHOP technique is an effective sequence-diagram modeling technique for novice analysts.