The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.

Molecular modeling of Bt Cry1Ac (DI–DII)–ASAL (Allium sativum lectin)–fusion protein and its interaction with aminopeptidase N (APN) receptor of Manduca sexta

Genetic engineering of Bacillus thuringiensis (Bt) Cry proteins has resulted in the synthesis of various novel toxin proteins with enhanced insecticidal activity and specificity towards different insect pests. In this study, a fusion protein consisting of the DI–DII domains of Cry1Ac and garlic lectin (ASAL) has been designed in silico by replacing the DIII domain of Cry1Ac with ASAL. The binding interface between the DI–DII domains of Cry1Ac and lectin has been identified using protein–protein docking studies. Free energy of binding calculations and interaction profiles between the Cry1Ac and lectin domains confirmed the stability of fusion protein. A total of 18 hydrogen bonds was observed in the DI–DII–lectin fusion protein compared to 11 hydrogen bonds in the Cry1Ac (DI–DII–DIII) protein. Molecular mechanics/Poisson–Boltzmann (generalized-Born) surface area [MM/PB (GB) SA] methods were used for predicting free energy of interactions of the fusion proteins. Protein–protein docking studies based on the number of hydrogen bonds, hydrophobic interactions, aromatic–aromatic, aromatic–sulphur, cation–pi interactions and binding energy of Cry1Ac/fusion proteins with the aminopeptidase N (APN) of Manduca sexta rationalised the higher binding affinity of the fusion protein with the APN receptor compared to that of the Cry1Ac–APN complex, as predicted by ZDOCK, Rosetta and ClusPro analysis. The molecular binding interface between the fusion protein and the APN receptor is well packed, analogously to that of the Cry1Ac–APN complex. These findings offer scope for the design and development of customized fusion molecules for improved pest management in crop plants.

Capturability of augmented proportional navigation (APN) guidance with nonlinear engagement dynamics

Proportional Navigation (PN) and its variants are widely used guidance philosophies. However, in the presence of target maneuver, PN guidance law is effective only for a restrictive set of initial geometries. To account for target maneuvers, the concept of Augmented Proportional Navigation (APN) guidance law was introduced and analyzed in a linearized interceptor-target engagement framework presented in literature. However, there is no work in the literature, that addresses the capturability performance of the APN guidance law in a nonlinear engagement framework. This paper presents such an analysis and obtains the conditions for capturability. It also shows that a shorter time of interception is obtained when APN is formulated in the nonlinear framework as proposed in this paper. Simulation results are given to support the theoretical findings.

The in vivo characterization of the DNA repair gene apn-1 in the model organism Caenorhabditis elegans

Les sites apuriniques/apyrimidinique (AP) représentent une forme de dommage à l’ADN hautement mutagène et ce type de dommage peut survenir spontanément ou être induit par une variété d’agents. Afin de préserver la stabilité génomique, deux familles d’endonucléases de type AP, endo-IV et exo-III, sont nécessaires pour contrecarrer les effets mutagènes des sites AP. Malgré l’identification de membres des deux familles dans plusieurs organismes unicellulaire tels que E.coli et S. cerevisiae, aucun membre de la famille endo-IV n’a été identifié chez les organismes multicellulaires à l’exception de C. elegans et de C. briggsae. Nous avons donc décidé d’investiguer l’importance biologique de APN-1 chez C. elegans par l’utilisation d’une approche de knockdown du gène. Dans notre étude, nous avons montré que le knockdown du gène apn-1 chez C. elegans, en utilisant des ARN d’interférence (ARNi), cause une accumulation de mutations spontanées et induites par des drogues résultant en un délai de l’éclosion des œufs ainsi que par une diminution de la survie et de la longévité des vers adultes. De plus, nous avons montré que cette accumulation de mutations mène à un délai dans la progression du cycle cellulaire durant l’embryogénèse, représentant possiblement une explication du délai dans l’éclosion des œufs. Nous avons montré qu’il y avait une augmentation du niveau de mutations dans la gorge des vers, sans toutefois pouvoir confirmer la distribution de APN-1 qui possède une étiquette GFP. Les animaux transgéniques APN-1-GFP n’exprimaient pas suffisamment de la protéine de fusion pour permettre une visualisation à l’aide d’un microscope à fluorescence, mais la protéine a été détectée par immunobuvardage de type western. Les animaux transgéniques APN-1-GFP étaient instables et avaient des phénotypes concordants avec les défauts génétiques. En conclusion, il semble que C. elegans aie évolué afin de retenir un niveau de base de APN-1 jouant ainsi un rôle versatile afin de maintenir l’intégrité génétique d’autant plus que cet organisme semble manquer plusieurs enzymes de la voie de réparation par excision de base.

Characterization of the AP endonuclease enzyme APN-1 from C. elegans

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Analysis of 'APN' naphthenic acids by high temperature gas chromatoagraphy and high performance liquid chromatography

Examination by high temperature GC (HTGC) of the methyl esters of the so-called 'ARN' naphthenic acids from crude oils of North Sea UK, Norwegian Sea and West African oilfields revealed the distributions of resolved 4-8 ring C-80 tetra acids and trace amounts of other acids. Whilst all three oils contained apparently the same the proportions of each differed, possibly reflecting the growth tempe acids, ratures of the archaebacteria from which the acids are assumed to have originated. The structures of the 4, 5, 7 and 8 ring acids are tentatively assigned by comparison with the known 6 ring acid and related natural products and an HPLC method for the isolation of the individual acids is described. ESI-MS of individual acids isolated by preparative HPLC established the elution order of the 4-8 ring acids on the HPLC and HTGC systems and revealed the presence of previously unreported acids tentatively identified as C-81 and C-82 7 and 8 ring analogues.

Operator's, organizational, and direct support maintenance manual : radar set AN/APN-215(V)1 (NSN-5841-01-093-1493) and radar set AN/APN-215(V)3 (NSN 5841-01-134-3346).

"23 November 1983."

Organizational, direct support, and general support maintenance repair parts and special tools lists ... for altimeter set, electronic, AN/APN-171A(V)1, (NSN 5841-00-144-7417).

"June 1978."

Operator's and organizational maintenance manual : radar set AN/APN-158.

"27 March 1964."

Organizational maintenance manual : altimeter set, electronic, AN/APN-171A(V)1.

"May 1969."

Direct support and general support maintenance repair parts and special tools lists ... : radar set AN/APN-158A (NSN-5841-00-143-4116).

"March 1979."