Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi – a systematic review and economic evaluation

Background: Sepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity. Objectives: To determine the clinical effectiveness and cost-effectiveness of three tests [LightCycler SeptiFast Test MGRADE® (Roche Diagnostics, Risch-Rotkreuz, Switzerland); SepsiTest™ (Molzym Molecular Diagnostics, Bremen, Germany); and the IRIDICA BAC BSI assay (Abbott Diagnostics, Lake Forest, IL, USA)] for the rapid identification of bloodstream bacteria and fungi in patients with suspected sepsis compared with standard practice (blood culture with or without matrix-absorbed laser desorption/ionisation time-offlight mass spectrometry). Data sources: Thirteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from January 2006 to May 2015 and supplemented by hand-searching relevant articles. Review methods: A systematic review and meta-analysis of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. A decision tree was used to estimate the costs and quality-adjusted life-years (QALYs) associated with each test; all other parameters were estimated from published sources. The model was populated with evidence from the systematic review or individual studies, if this was considered more appropriate (base case 1). In a secondary analysis, estimates (based on experience and opinion) from seven clinicians regarding the benefits of earlier test results were sought (base case 2). A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Scenario analyses were used to assess uncertainty. Results: For the review of diagnostic test accuracy, 62 studies of varying methodological quality were included. A meta-analysis of 54 studies comparing SeptiFast with blood culture found that SeptiFast had an estimated summary specificity of 0.86 [95% credible interval (CrI) 0.84 to 0.89] and sensitivity of 0.65 (95% CrI 0.60 to 0.71). Four studies comparing SepsiTest with blood culture found that SepsiTest had an estimated summary specificity of 0.86 (95% CrI 0.78 to 0.92) and sensitivity of 0.48 (95% CrI 0.21 to 0.74), and four studies comparing IRIDICA with blood culture found that IRIDICA had an estimated summary specificity of 0.84 (95% CrI 0.71 to 0.92) and sensitivity of 0.81 (95% CrI 0.69 to 0.90). Owing to the deficiencies in study quality for all interventions, diagnostic accuracy data should be treated with caution. No randomised clinical trial evidence was identified that indicated that any of the tests significantly improved key patient outcomes, such as mortality or duration in an intensive care unit or hospital. Base case 1 estimated that none of the three tests provided a benefit to patients compared with standard practice and thus all tests were dominated. In contrast, in base case 2 it was estimated that all cost per QALY-gained values were below £20,000; the IRIDICA BAC BSI assay had the highest estimated incremental net benefit, but results from base case 2 should be treated with caution as these are not evidence based. Limitations: Robust data to accurately assess the clinical effectiveness and cost-effectiveness of the interventions are currently unavailable. Conclusions: The clinical effectiveness and cost-effectiveness of the interventions cannot be reliably determined with the current evidence base. Appropriate studies, which allow information from the tests to be implemented in clinical practice, are required.

Leadership and emotional intelligence in nursing and midwifery education and practice: a discussion paper

Aim
A discussion of the concepts of leadership and emotional intelligence in nursing and midwifery education and practice.

Background
The need for emotionally intelligent leadership in the health professions is acknowledged internationally throughout the nursing and midwifery literature. The concepts of emotional intelligence and emotional-social intelligence have emerged as important factors for effective leadership in the healthcare professions and require further exploration and discussion. This paper will explore these concepts and discuss their importance in the healthcare setting with reference to current practices in the UK, Ireland and internationally.

Design
Discussion paper.

Data sources
A search of published evidence from 1990–2015 using key words (as outlined below) was undertaken from which relevant sources were selected to build an informed discussion.

Implications for nursing/midwifery
Fostering emotionally intelligent leadership in nursing and midwifery supports the provision of high quality and compassionate care. Globally, leadership has important implications for all stakeholders in the healthcare professions with responsibility for maintaining high standards of care. This includes all grades of nurses and midwives, students entering the professions, managerial staff, academics and policy makers.

Conclusion
This paper discusses the conceptual models of leadership and emotional intelligence and demonstrates an important link between the two. Further robust studies are required for ongoing evaluation of the different models of emotional intelligence and their link with effective leadership behaviour in the healthcare field internationally. This is of particular significance for professional undergraduate education to promote ongoing compassionate, safe and high quality standards of care.

Comparing sensor-based and camera-based approaches to recognizing the occupancy status of the load handling device of forklift trucks

Real-time data of key performance enablers in logistics warehouses are of growing importance as they permit decision-makers to instantaneously react to alerts, deviations and damages. Several technologies appear as adequate data sources to collect the information required in order to achieve the goal. In the present re-search paper, the load status of the fork of a forklift is to be recognized with the help of a sensor-based and a camera-based solution approach. The comparison of initial experimentation results yields a statement about which direction to pursue for promising further research.

Stumbling Blocks in Empirical Legal Research: Case Study Research

This article examines the main assumptions and theoretical underpinnings of case study method in legal studies. It considers the importance of research design, including the crucial roles of the academic literature review, the research question and the use of rival theories to develop hypotheses and the practice of identifying the observable implications of those hypotheses. It considers the selection of data sources and modes of analysis to allow for valid analytical inferences to be drawn in respect of them. In doing so it considers, in brief, the importance of case study selection and variations such as single or multi case approaches. Finally it provides thoughts about the strengths and weaknesses associated with undertaking socio-legal and comparative legal research via a case study method, addressing frequent stumbling blocks encountered by legal researchers, as well as ways to militate them. It is written with those new to the method in mind.

Confluent Learning: Using a Design Approach to Develop Cognitive Abilities and Enhance Affective Capacities Through Change Management Curriculum

Purpose The aim of the study is to explore the role of confluent learning in supporting the development of change management knowledge, skills and attitudes and to inform the creation of a conceptual model based upon a priori and a posteriori knowledge gained from literature and the research. Design/methodology/approach The research adopts qualitative approach based on reflective inquiry methodology. There are two primary data sources, interviews with learners and the researchers’ reflective journals on learners’ opinions. Findings The confluent learning approach helped to stimulate affective states (e.g. interest and appreciation) to further reinforce cognitive gains (e.g. retention of knowledge) as a number of higher order thinking skills were further developed. The instructional design premised upon confluent learning enabled learners to further appreciate the complexities of change management. Research implications/ limitations The confluent learning approach offers another explanation to how learning takes place, contingent upon the use of a problem solving framework, instructional design and active learning in developing inter- and trans-disciplinary competencies. Practical implications This study not only explains how effective learning takes place but is also instructive to learning and teaching, and human resource development (HRD) professionals in curriculum design and the potential benefits of confluent learning. Social implications The adoption of a confluent learning approach helps to re-naturalise learning that appeals to learners affect. Originality/value This research is one of the few studies that provide an in-depth exploration of the use of confluent learning and how this approach co-develops cognitive abilities and affective capacity in the creation of a conceptual model.

Estimating the effect of state-level gun purchasing policy on county-level firearm suicide mortality

Thesis (Master's)--University of Washington, 2016-08

Learning from Text: Examining Teacher Thinking and Practice in AP Environmental Science

Thesis (Ph.D.)--University of Washington, 2016-08

Bayesian Methods for Inferring Gene Regulatory Networks

Thesis (Ph.D.)--University of Washington, 2016-08

Bento Box Discovery

Poster presentation at the University of Maryland Libraries Research & Innovative Practice Forum on June 8, 2016. The poster proposes that the UMD Libraries should evaluate adoption of Bento Box Discovery for improved user search experience.

An Analysis of the Implementation and Perceived Effectiveness of the SchoolMAX Family Portal

ABSTRACT Title of Document: AN ANALYSIS OF THE IMPLEMENTATION AND PERCEIVED EFFECTIVENESS OF THE SCHOOLMAX FAMILY PORTAL Warren Wesley Watts, Doctor of Education, 2015 Directed By: Margaret J. McLaughlin, Ph.D. Department of Counseling, Higher Education and Special Education School districts have spent millions of dollars implementing student information systems that offer family portals with web-based access to parents and students. One of the main purposes of these systems is to improve school-to-home communication. Research has shown that when school-to-home communication is implemented effectively, parent involvement improves and student achievement increases (Epstein, 2001). The purpose of the study was to (a) understand why parents used or refrained from using the family portal and (b) determine what barriers to use might exist. To this end, this descriptive study identified the information parent users accessed in the SchoolMAX family portal, determined how frequently parents accessed the portal, and ascertained whether parents perceived an increase in communication with their children about academic matters after they began accessing the portal. Finally, the study sought to identify whether barriers existed that prevented parents from using the family portal. The inquiry employed three data sources to answer the aforementioned queries. These sources included (a) a survey sent electronically to 19,108 parents who registered online for the SchoolMAX family portal; (b) SchoolMAX portal usage data from the student information system for system usage between January 1, 2015 and June 30, 2015; and (c) a paper survey sent to 691 parents of students that had never used the SchoolMAX family portal in one elementary school, one middle school and one high school that were representative of other schools in the district. Survey results indicated that parents at all grade levels used the family portal. Usage data also confirmed that approximately 19% of the students had parents who monitored their progress through the family portal. Usage data also showed that parents were monitoring approximately 25% of students in secondary schools (6th – 12th grade) and 16% of students in elementary schools. Of the wide menu of resources available through the SchoolMAX family portal, parents used three areas most frequently: attendance, daily grades, and report cards. Approximately 70% of parents responded that their communication had improved with their children about academic matters since they started using the SchoolMAX family portal, and 90% of parents responded that the SchoolMAX family portal was an effective or somewhat effective tool. Parents also expressed interest in the addition of additional information to the SchoolMAX family portal. Specifically, the top three additions parents wanted to see included homework assignments, high stakes test scores, and graduation requirements. Parents also reported that 92% of them spoke to their children at least 2 to 3 times per week about academics. Due to the low response rate of the parent non-user survey, potential barriers to using the SchoolMAX family portal could not be addressed in this study. However, this issue may be a useful research topic in a future study. Keywords: school to home communication, student information systems, family portal, parent portal

Defining the Resolution of a Network for Transportation Analyses: a New Method to Improve Transportation Planning Decisions

Travel demand models are important tools used in the analysis of transportation plans, projects, and policies. The modeling results are useful for transportation planners making transportation decisions and for policy makers developing transportation policies. Defining the level of detail (i.e., the number of roads) of the transport network in consistency with the travel demand model’s zone system is crucial to the accuracy of modeling results. However, travel demand modelers have not had tools to determine how much detail is needed in a transport network for a travel demand model. This dissertation seeks to fill this knowledge gap by (1) providing methodology to define an appropriate level of detail for a transport network in a given travel demand model; (2) implementing this methodology in a travel demand model in the Baltimore area; and (3) identifying how this methodology improves the modeling accuracy. All analyses identify the spatial resolution of the transport network has great impacts on the modeling results. For example, when compared to the observed traffic data, a very detailed network underestimates traffic congestion in the Baltimore area, while a network developed by this dissertation provides a more accurate modeling result of the traffic conditions. Through the evaluation of the impacts a new transportation project has on both networks, the differences in their analysis results point out the importance of having an appropriate level of network detail for making improved planning decisions. The results corroborate a suggested guideline concerning the development of a transport network in consistency with the travel demand model’s zone system. To conclude this dissertation, limitations are identified in data sources and methodology, based on which a plan of future studies is laid out.

Meta-analysis of the influence of chronic kidney disease on the risk of thromboembolism among patients with nonvalvular atrial fibrillation

Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist. However, the extent to which CKD increases the risk of thromboembolism in patients with nonvalvular AF and the benefits of anticoagulation in this group remain unclear. We addressed the role of CKD in the prediction of thromboembolic events and the impact of anticoagulation using a meta-analysis method. Data sources included MEDLINE, EMBASE, and Cochrane (from inception to January 2014). Three independent reviewers selected studies. Descriptive and quantitative information was extracted from each selected study and a random-effects meta-analysis was performed. After screening 962 search results, 19 studies were considered eligible. Among patients with AF, the presence of CKD resulted in an increased risk of thromboembolism (hazard ratio [HR] 1.46, 95% confidence interval [CI] 1.20 to 1.76, p = 0.0001), particularly in case of end-stage CKD (HR 1.83, 95% CI 1.56 to 2.14, p <0.00001). Warfarin decreased the incidence of thromboembolic events in patients with non-end-stage CKD (HR 0.39, 95% CI 0.18 to 0.86, p <0.00001). Recent data on novel oral anticoagulants suggested a higher efficacy of these agents compared with warfarin (HR 0.80, 95% CI 0.66 to 0.96, p = 0.02) and aspirin (HR 0.32, 95% CI 0.19 to 0.55, p <0.0001) in treating non-end-stage CKD. In conclusion, the presence of CKD in patients with AF is associated with an almost 50% increased thromboembolic risk, which can be effectively decreased with appropriate antithrombotic therapy. Further prospective studies are needed to better evaluate the interest of anticoagulation in patients with severe CKD.

Configurable Web Warehouses construction through BPM Systems

The process of building Data Warehouses (DW) is well known with well defined stages but at the same time, mostly carried out manually by IT people in conjunction with business people. Web Warehouses (WW) are DW whose data sources are taken from the web. We define a flexible WW, which can be configured accordingly to different domains, through the selection of the web sources and the definition of data processing characteristics. A Business Process Management (BPM) System allows modeling and executing Business Processes (BPs) providing support for the automation of processes. To support the process of building flexible WW we propose a two BPs level: a configuration process to support the selection of web sources and the definition of schemas and mappings, and a feeding process which takes the defined configuration and loads the data into the WW. In this paper we present a proof of concept of both processes, with focus on the configuration process and the defined data.

A Figured Worlds Perspective on Middle School Learners' Climate Literacy Development

The purpose of this study was to investigate the nature of the relationship between middle school science learners’ conditions and their developing understandings of climate change. I applied the anthropological theoretical perspective of figured worlds (Holland, Lachicotte, Skinner, & Cain, 1998) to examine learners’ views of themselves and their capacities to act in relation to climate change. My overarching research question was: How are middle school science learners’ figured worlds of climate change related to the conditions in which they are embedded? I used a descriptive single-case study design to examine the climate change ideas of eight purposefully selected 6th grade science learners. Data sources included: classroom observations, curriculum documents, interviews, focus groups, and written assessments and artifacts, including learners’ self- generated drawings. I identified six analytic lenses with which to explore the data. Insights from the application of these analytic lenses provided information about the elements of participants’ climate change stories, which I reported through the use of a storytelling heuristic. I then synthesized elements of participants’ collective climate change story, which provided an “entrance” (Kitchell, Hannan, & Kempton, 2000, p. 96) into their figured world of climate change. Aspects of learners’ conditions—such as their worlds of school, technology and media use, and family—appeared to shape their figured world of climate change. Within their figured world of climate change, learners saw themselves—individually and as members of groups—as inhabiting a variety of climate change identities, some of which were in conflict with each other. I posited that learners’ enactment of these identities – or the ways in which they expressed their climate change agency – had the potential to reshape or reinforce their conditions. Thus, learners’ figured worlds of climate change might be considered “spaces of authoring” (Holland et al., 1998, p. 45) with potential for inciting social and environmental change. The nature of such change would hinge on the extent to which these nascent climate change identities become salient for these early adolescent learners through their continued climate change learning experiences. Implications for policy, curriculum and instruction, and science education research related to climate change education are presented.

Nineteenth century narratives reveal historic catch rates for Australian snapper (Pagrus auratus)

Snapper (Pagrus auratus) is widely distributed throughout subtropical and temperate southern oceans and forms a significant recreational and commercial fishery in Queensland, Australia. Using data from government reports, media sources, popular publications and a government fisheries survey carried out in 1910, we compiled information on individual snapper fishing trips that took place prior to the commencement of fisherywide organized data collection, from 1871 to 1939. In addition to extracting all available quantitative data, we translated qualitative information into bounded estimates and used multiple imputation to handle missing values, forming 287 records for which catch rate (snapper fisher−1 h−1) could be derived. Uncertainty was handled through a parametric maximum likelihood framework (a transformed trivariate Gaussian), which facilitated statistical comparisons between data sources. No statistically significant differences in catch rates were found among media sources and the government fisheries survey. Catch rates remained stable throughout the time series, averaging 3.75 snapper fisher−1 h−1 (95% confidence interval, 3.42–4.09) as the fishery expanded into new grounds. In comparison, a contemporary (1993–2002) south-east Queensland charter fishery produced an average catch rate of 0.4 snapper fisher−1 h−1 (95% confidence interval, 0.31–0.58). These data illustrate the productivity of a fishery during its earliest years of development and represent the earliest catch rate data globally for this species. By adopting a formalized approach to address issues common to many historical records – missing data, a lack of quantitative information and reporting bias – our analysis demonstrates the potential for historical narratives to contribute to contemporary fisheries management.