An analysis of the shortage of registered nurses (RNs) in acute care hospitals in El Paso, Texas

The purpose of this analysis of the shortage of Registered Nurses (RNs) in acute care hospitals in El Paso, Texas, was to evaluate twenty-two specific organizational and/or patient care unit (nursing unit) characteristics that effect the retention and turnover of professional nurses. Vacancy Rates were used to measure the level of the shortage in each hospital and nursing unit in the study. Vacancy Rates are a function of both RN retention and RN turnover. Seventy-three patient care units in five acute care hospitals were included in the study population.^ Fredrick Herzberg's motivational - hygiene theory was used to explain the types of characteristics or factors that can effect worker dissatisfaction. Dissatisfiers (hygiene factors) are those work place characteristics that influence workers to leave the job. The twenty-two potentially dissatisfying work place characteristics were either organizational or patient care unit specific in nature. The focus of the study was to evaluate high vacancy rates caused by both low retention of RNs and high turnover rates. Retention and turnover are a function of workers (RNs) not staying in their jobs, therefore hygiene factors were appropriate characteristics to study.^ Various multivariate analysis techniques were used to assess both the individual and combined effects of the hygiene factors on Vacancy Rates, Retention and Turnover. Results suggest that certain organizational and patient care unit characteristics are associated with and have a statistically significant effect on vacancy rates, and the retention and turnover of RNs. The type of Hospital was of particular interest in this regards. For-Profit facilities were less effected by most of the study variables than the Not-for-Profits. ^

International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey

Background: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people. Aim: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics. Design and setting: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand. Method: The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L). Results: A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio [OR] 0.74 [95% confidence interval [CI] = 0.63 to 0.87]). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 [95% CI = 5.81 to 15.5]). Conclusion: GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care

Does outmigration lead to land degradation? Labour shortage and land management in a western Nepal watershed

In Nepal, changing demographic patterns are leading to changes in land use. The high level of outmigration of men in the hills of Kaski District, Western Development Region of Nepal, is affecting the household structure but also land management. Land is often abandoned, as the burden on those left behind is too high. How do these developments affect the state of the land in terms of land degradation? To find out, we studied land degradation, land abandonment caused by outmigration, and existing sustainable land management practices in a subwatershed in Kaski District. Mapping was done using the methodology of the World Overview of Conservation Approaches and Technologies (WOCAT). While previous studies expected land abandonment to exacerbate slope erosion, we demonstrate in this paper that it is in fact leading to an increase in vegetation cover due to favourable conditions for ecosystem recovery. However, negative impacts are several, including the increase of invasive species harmful to livestock and a decline in soil fertility. Traditional land management practices such as terraces and forest management exist. To date, however, these measures fail to take account of the changing population dynamics in the region, making the question of how migration and land degradation are linked worth revisiting.

CPA Shortage

This report is on current issue of the shortage of Certified Public Accountants. It discusses the reasons for the shortage, such as the newest 150-hour requirement, as well as the increased need for accountants after Sarbanes-Oxley. Also, It discusses what companies are doing to get more people into the accounting profession and keep the people they have. There is also a Case Study on what Deloitte & Touche is doing to help their firm. This paper develops ideas and possible solutions to help accounting firms deal with and change the current shortage situation they are in.

Influenza vaccination and peoples' knowledge and attitudes towards it: Factors that influenced influenza vaccination during the 2004--2005 influenza vaccine shortage

Influenza and pneumonia together comprise the seventh leading cause of death among adults in the U.S and were responsible for 65,163 deaths in 2003 and an average of 36,000 deaths per year in the United States from 1990 to 1999. Vaccination is efficacious and cost-effective in terms of preventing the infection and reducing both health care costs and productivity losses associated with influenza illness. The vaccine shortage of 2004–2005 resulted in a 39% decrease in the influenza vaccine supplies. During the fall of 2004, we conducted a nationwide, random-digit dialing, telephonic-interview survey of 1,202 adults aged 18 years and older to ascertain influenza vaccine knowledge, attitude and behavior. Of the 1,202 total interviewed subjects, 44.7% had received or intended to receive vaccine at the time of the survey (2004–05) and 39.6% had received the influenza vaccine the previous year (2003–04). Receipt of vaccine increased with previous receipt of the influenza vaccine (OR 13.17, 95% CI 8.65–20.08), increased motivation status (OR 7.58, 95% CI 4.03–14.25), subjective risk status (OR 3.33, 95% CI 2.23–4.97), age (OR 1.83, 95% CI 1.22–2.75) and previous receipt of the pneumococcal vaccine (OR 1.75, 95% CI 1.02–3.0). The influenza vaccine shortage of 2004–05 did not have a negative impact on the vaccination rates of study population. In addition to the increased rates, a large majority of respondents were also aware of the shortage of influenza vaccine during the 2004–05 season, about the indications for receiving the influenza vaccine, about alternative methods to prevent contracting the influenza and increased motivation to receive the vaccine. ^

Particle methods parallel implementations by GP-GPU strategies

This paper outlines the problems found in the parallelization of SPH (Smoothed Particle Hydrodynamics) algorithms using Graphics Processing Units. Different results of some parallel GPU implementations in terms of the speed-up and the scalability compared to the CPU sequential codes are shown. The most problematic stage in the GPU-SPH algorithms is the one responsible for locating neighboring particles and building the vectors where this information is stored, since these specific algorithms raise many dificulties for a data-level parallelization. Because of the fact that the neighbor location using linked lists does not show enough data-level parallelism, two new approaches have been pro- posed to minimize bank conflicts in the writing and subsequent reading of the neighbor lists. The first strategy proposes an efficient coordination between CPU-GPU, using GPU algorithms for those stages that allow a straight forward parallelization, and sequential CPU algorithms for those instructions that involve some kind of vector reduction. This coordination provides a relatively orderly reading of the neighbor lists in the interactions stage, achieving a speed-up factor of x47 in this stage. However, since the construction of the neighbor lists is quite expensive, it is achieved an overall speed-up of x41. The second strategy seeks to maximize the use of the GPU in the neighbor's location process by executing a specific vector sorting algorithm that allows some data-level parallelism. Al- though this strategy has succeeded in improving the speed-up on the stage of neighboring location, the global speed-up on the interactions stage falls, due to inefficient reading of the neighbor vectors. Some changes to these strategies are proposed, aimed at maximizing the computational load of the GPU and using the GPU texture-units, in order to reach the maximum speed-up for such codes. Different practical applications have been added to the mentioned GPU codes. First, the classical dam-break problem is studied. Second, the wave impact of the sloshing fluid contained in LNG vessel tanks is also simulated as a practical example of particle methods

Applicability of the GP Device to the Circle of Willis Arteries by Using a Mathematical Model

According to the World Health Organization, 15 million people suffer stroke worldwide each year, of these, 5 million die and 5 million are permanently disabled. Stroke is therefore a major cause of mortality world-wide. The majority of strokes are caused by a blood clot that occludes an artery in the brain, and although thrombolytic agents such as Alteplase are used to dissolve clots that arise in the arteries of the brain, there are limitations on the use of these thrombolytic agents. However over the past decade, other methods of treatment have been developed which include Thrombectomy Devices e.g. the 'GP' Thrombus Aspiration Device ('GP' TAD). Such devices may be used as an alternative to thrombolytics or in conjunction with them to extract blood clots in arteries such as the middle cerebral artery of the midbrain brain, and the posterior inferior cerebellar artery (PICA) of the posterior aspect of the brain. In this paper, we mathematically model the removal of blood clots using the 'GP' TAD from selected arteries of the brain where blood clots may arise taking into account factors such as the resistances, compliances and inertances effects. Such mathematical modelling may have potential uses in predicting the pressures necessary to extract blood clots of given lengths, and masses from arteries in the Circle of Willis - posterior circulation of the brain

Optimal water allocation in shortage situations as applied to an irrigation community.

This work studies the most beneficial way of allocating water in an irrigation community in water shortage situations. Therefore, it proposes that the irrigation surface area be divided into homogeneous zones, each with a beneficial relationship with respect to the water applied. The mathematical formula that enables one to obtain the optimal quota for the users or irrigation community as a whole has been found for individual relations of a quadratic or power type, and these have yielded different and complementary characteristics. Dimensionless variables have been used to display the results, and to compare with other alternative allocation rules such as the proportional rule, referencing the situation without water restrictions. As a result, for each water shortage situation, the water that is allocated to each user is obtained, together with the losses in individual income and the losses for the community as a whole. Furthermore, a proposal is put forth for establishing the marginal benefit from the water available, which could be of interest in enabling each community to analyze whether it is in its best interest to invest in increasing the resource, or to sell the resource to other users. Finally, an example is given to demonstrate how the method works and to show that, when the differences between the production schemes are considered, the differences in benefit reduction between the proportional allocation and the optimal allocation are also sizeable. Read More: http://ascelibrary.org/doi/abs/10.1061/(ASCE)IR.1943-4774.0000667

The optimal allocation rule and the water market as the most effective tools of managing water shortage in an irrigation district

The conference program will cover all areas of environmental and resource economics, ranging from topics prevailing in the general debate, such as climate change, energy sources, water management and ecosystem services evaluation, to more specialized subjects such as biodiversity conservation or persistent organic pollutants. The congress will be held on the Faculty of Economics of the University of Girona, located in Montilivi, a city quarter situated just few minutes from the city center, conveniently connected by bus lines L8 and L11.

Effects of inefficient cleavage of the signal sequence of HIV-1 gp 120 on its association with calnexin, folding, and intracellular transport.

The HIV-1 envelope glycoprotein gp120 displays inefficient intracellular transport, which is caused by its retention in the endoplasmic reticulum. Coexpression in insect cells (Sf9) of HIV-1 gp120 with calnexin has shown that their interaction was modulated by the signal sequence of HIV-1 gp120. gp120, with its natural signal sequence, showed a prolonged association with calnexin with a t1/2 of greater than 20 min. Replacement of the natural signal sequence with the signal sequence from mellitin led to a decreased time of association of gp120 with calnexin (t1/2 < 10 min). These different times of calnexin association coincided both with the folding of gp120 as measured by the ability of bind CD4 and with endoplasmic reticulum to Golgi transport as analyzed by the acquisition of partial endoglycosidase H resistance. Using a monospecific antibody to the HIV-1 gp120 natural signal peptide, we showed that calnexin associated with N-glycosylated but uncleaved gp120. Only after dissociation from calnexin was gp120 cleaved, but very inefficiently. Only the small proportion of signal-cleaved gp120 molecules acquired transport competence and were secreted. This is the first report demonstrating the effect of the signal sequence on calnexin association.