Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

Recognition and enforcement in cross-border insolvency law: A proposal for judicial gap-filling

This Article analyzes the recognition and enforcement of cross-border insolvency judgments from the United States, United Kingdom, and Australia to determine whether the UNCITRAL Model Law’s goal of modified universalism is currently being practiced, and subjects the Model Law to analysis through the lens of international relations theories to elaborate a way forward. We posit that courts could use the express language of the Model Law text to confer recognition and enforcement of foreign insolvency judgments. The adoption of our proposal will reduce costs, maximize recovery for creditors, and ensure predictability for all parties.

Recognition And Top-Down Generation Of Beta-Acyclic Database Schemes

Database schemes can be viewed as hypergraphs with individual relation schemes corresponding to the edges of a hypergraph. Under this setting, a new class of "acyclic" database schemes was recently introduced and was shown to have a claim to a number of desirable properties. However, unlike the case of ordinary undirected graphs, there are several unequivalent notions of acyclicity of hypergraphs. Of special interest among these are agr-, beta-, and gamma-, degrees of acyclicity, each characterizing an equivalence class of desirable properties for database schemes, represented as hypergraphs. In this paper, two complementary approaches to designing beta-acyclic database schemes have been presented. For the first part, a new notion called "independent cycle" is introduced. Based on this, a criterion for beta-acyclicity is developed and is shown equivalent to the existing definitions of beta-acyclicity. From this and the concept of the dual of a hypergraph, an efficient algorithm for testing beta-acyclicity is developed. As for the second part, a procedure is evolved for top-down generation of beta-acyclic schemes and its correctness is established. Finally, extensions and applications of ideas are described.

The DISC1 Pathway in the Genetic Etiology of Schizophrenia

Schizophrenia is a severe psychotic disorder affecting 0.5-1 % of the population. The disorder is characterized by hallucinations; delusions; disorganized behavior and speech; avolition; anhedonia; flattened affect and cognitive deficits. The etiology of the disorder is complex with evidence for multiple genes contributing to the onset of the disorder along with environmental factors. DISC1 is one of the most promising candidate genes for schizophrenia. It codes for a protein which takes part in numerous molecular interactions along several pathways. This network, termed as the DISC1 pathway, is evidently important for the development and maturation of the central nervous system from the embryo until young adulthood. Disruption at these pathways is thought to predispose schizophrenia. In the present study, we have studied the DISC1 pathway in the etiology of schizophrenia in the Finnish population. We have utilized large Finnish samples; the schizophrenia family sample where DISC1 was originally shown to associate with schizophrenia and the Northern Finland birth cohort 1966 (NFBC66). Several DISC1 binding partners displayed evidence for association in the family sample along with DISC1. Through a genome-wide linkage study, we found a significant linkage signal to a locus where a DISC1 binding partner NDE1 is located at the carriers of a certain DISC1 risk variant. In a follow-up study, genetic markers in NDE1 displayed significant evidence for association with schizophrenia. Further exploration of association between 11 genes of the DISC1 pathway and schizophrenia led to recognition of novel variants in NDEL1, PDE4B and PDE4D that significantly either increased or decreased the risk for schizophrenia. Further, we found evidence that DISC1 itself has a significant role in the human mental functioning even in the healthy population. Variants in DISC1 had a significant effect on anhedonia which is a trait present at everybody but is in its severe form one of the main symptoms of schizophrenia and correlates with the risk of developing the disorder. Further, utilizing genome-wide marker data, we recognized three genes; MIR620; CCDC141 and LCT; that are closely related to the DISC1 pathway but which effects on anhedonia were observable only at the individuals who carried these specific DISC1 variants. Our findings significantly add up to the previous evidence for the involvement of DISC1 and the DISC1 pathway in the etiology of schizophrenia and psychosis. Our results support the concept of a number of DISC1 pathway related genes contributing in the etiology of schizophrenia along with DISC1 and provide new candidates for the studies of schizophrenia. Our findings also significantly increase the importance of DISC1 itself as having a role in psychological functioning in the general population.

Audience members watching the opening ceremonies of the Heidelberg festival, with opening speech given by Thomas Mann.

Typed caption: Festakt in der Stadthalle zur Eroeffnung der Heidelberger Festpiele 1929. Thomas Mann hielt die Festrede. Unsere Aufnahme zeigt einen Ausschnitt aus der Festversammlung, an der die geistige Prominenz Heidelbergs und zahlreiche bedeutende Persoenlichkeiten des deutschen Kulturlebends teilnahmen. Von links nach rechts in der 1. Reihe: Rene Schickele, Rudolf Rittner, Gustav Hargung, Prof. Dr. Martin Dibelius, Gerhart Hauptmann, Dr. Rudolf H. Goldschmidt, Oberbuergermeister Dr. Neinhaus, Thomas Mann und Frau, Kultusminister Leers, Rudolf G. Binding; In der 3. Reihe: Oberbaurat L. Schmieder, Nobelpreistraeger Dr. F. Bergius, Bankdirektor Fremerey, Prof. Hellpach, Prof. Radbruch

Dynamic Space Warping Of Strokes For Recognition Of Online Handwritten Characters

This paper suggests a scheme for classifying online handwritten characters, based on dynamic space warping of strokes within the characters. A method for segmenting components into strokes using velocity profiles is proposed. Each stroke is a simple arbitrary shape and is encoded using three attributes. Correspondence between various strokes is established using Dynamic Space Warping. A distance measure which reliably differentiates between two corresponding simple shapes (strokes) has been formulated thus obtaining a perceptual distance measure between any two characters. Tests indicate an accuracy of over 85% on two different datasets of characters.

Compressive Sensing For Sparsely Excited Speech Signals

Compressive sensing (CS) has been proposed for signals with sparsity in a linear transform domain. We explore a signal dependent unknown linear transform, namely the impulse response matrix operating on a sparse excitation, as in the linear model of speech production, for recovering compressive sensed speech. Since the linear transform is signal dependent and unknown, unlike the standard CS formulation, a codebook of transfer functions is proposed in a matching pursuit (MP) framework for CS recovery. It is found that MP is efficient and effective to recover CS encoded speech as well as jointly estimate the linear model. Moderate number of CS measurements and low order sparsity estimate will result in MP converge to the same linear transform as direct VQ of the LP vector derived from the original signal. There is also high positive correlation between signal domain approximation and CS measurement domain approximation for a large variety of speech spectra.

A lifespan perspective on emotion regulation, stress, and well-being in the workplace

Researchers in the field of occupational stress and well-being are increasingly interested in the role of emotion regulation in the work context. Emotion regulation has also been widely investigated in the area of lifespan developmental psychology, with findings indicating that the ability to modify one's emotions represents a domain in which age-related growth is possible. In this chapter, we integrate the literatures on aging, emotion regulation, and occupational stress and well-being. To this end, we review key theories and empirical findings in each of these areas, summarize existing research on age, emotion regulation, and stress and well-being at work, and develop a conceptual model on how aging affects emotion regulation and the stress process in work settings to guide future research. According to the model, age will affect: (1) what kinds of affective work events are encountered and how often; (2) the appraisal of and initial emotional response to affective work events (emotion generation), and; (3) the management of emotions and coping with affective work events (emotion regulation). The model has implications for researchers and practitioners who want to understand and facilitate successful emotion regulation and stress reduction in the workplace among different age groups.

Differential recognition by tick-resistant cattle of the recombinantly expressed Rhipicephalus microplus serine protease inhibitor-3 (RMS-3)

Rhipicephalus micro plus is an important bovine ectoparasite, widely distributed in tropical and subtropical regions of the world causing large economic losses to the cattle industry. Its success as an ectoparasite is associated with its capacity to disarm the antihemostatic and anti-inflammatory reactions of the host. Serpins are protease inhibitors with an important role in the modulation of host-parasite interactions. The cDNA that encodes for a R. microplus serpin was isolated by RACE and subsequently cloned into the pPICZ alpha A vector. Sequence analysis of the cDNA and predicted amino acid showed that this cDNA has a conserved serpin domain. B- and T-cell epitopes were predicted using bioinformatics tools. The recombinant R. microplus serpin (rRMS-3) was secreted into the culture media of Pichia pastoris after methanol induction at 0.2 mg l(-1) qRT-PCR expression analysis of tissues and life cycle stages demonstrated that RMS-3 was mainly expressed in the salivary glands of female adult ticks. Immunological recognition of the rRMS-3 and predicted B-cell epitopes was tested using tick-resistant and susceptible cattle sera. Only sera from tick-resistant bovines recognized the B-cell epitope AHYNPPPPIEFT (Seq7). The recombinant RMS-3 was expressed in P. pastoris, and ELISA screening also showed higher recognition by tick-resistant bovine sera. The results obtained suggest that RMS-3 is highly and specifically secreted into the bite site of R. microplus feeding on tick-resistant bovines. Capillary feeding of semi-engorged ticks with anti-AHYNPPPPIEFT sheep sera led to an 81.16% reduction in the reproduction capacity of R. microplus. Therefore, it is possible to conclude that R. microplus serpin (RMS-3) has an important role in the host-parasite interaction to overcome the immune responses in resistant cattle. (C) 2012 Elsevier GmbH. All rights reserved.

Improved optical character recognition by matched filtering

The effectiveness of linear matched filters for improved character discrimination in presence of random noise and poorly defined characters has been investigated. We have found that although the performance of the filter in presence of random noise is reasonably good (16 dB gain in signal-to-noise-ratio) its performance is poor when the unknown character is distorted (linear shift and rotation).

Improved optical character recognition by matched filtering

The effectiveness of linear matched filters for improved character discrimination in presence of random noise and poorly defined characters has been investigated. We have found that although the performance of the filter in presence of random noise is reasonably good (16 dB gain in signal-to-noise-ratio) its performance is poor when the unknown character is distorted (linear shift and rotation).

Activity recognition using binary tree SVM

This paper presents an effective classification method based on Support Vector Machines (SVM) in the context of activity recognition. Local features that capture both spatial and temporal information in activity videos have made significant progress recently. Efficient and effective features, feature representation and classification plays a crucial role in activity recognition. For classification, SVMs are popularly used because of their simplicity and efficiency; however the common multi-class SVM approaches applied suffer from limitations including having easily confused classes and been computationally inefficient. We propose using a binary tree SVM to address the shortcomings of multi-class SVMs in activity recognition. We proposed constructing a binary tree using Gaussian Mixture Models (GMM), where activities are repeatedly allocated to subnodes until every new created node contains only one activity. Then, for each internal node a separate SVM is learned to classify activities, which significantly reduces the training time and increases the speed of testing compared to popular the `one-against-the-rest' multi-class SVM classifier. Experiments carried out on the challenging and complex Hollywood dataset demonstrates comparable performance over the baseline bag-of-features method.

A model for visual recognition of alphanumerics

In this paper we propose a hypothetical scheme for recognizing the alphanumerics. The scheme is based on the known physiological structure of the visual cortex and the concept of a short Lino extractor nouron (SLEN). We assumo four basic typca of such units for extracting vertical, horizontal, right and left inclined straight line segments. The patterns reconstructed from the scheme show perfect agreement with the test patterns. The model indicates that the recognition of letters T and H requires extraction of the largest number of features.