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More than 795,000 American adults have a stroke annually. About 610,000 are first or new strokes. Almost 140,000 Americans of all ages die of a stroke every year (Centers for Disease Control and Prevention [CDC], 2017). Stroke requires emergent treatment and an exact clinical order pathway to ensure better patient outcomes and compliance with the standards of care defined by regulatory bodies such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). While stroke management teams often include an Advanced Practice Nurse (APN), there is a lack of a standardized protocol across New Jersey (NJ) and ambiguity about the role of APNs managing stroke. This quality improvement educational initiative, Stroke Clinical Order Pathways Education (SCOPE) for APNs, was conducted for APNs in NJ to emphasize the importance of the stroke clinical pathway order sets (Appendix A) to improve quality of care for stroke patients and to clearly define the role of APNs. This Doctor of Nursing (DNP) educational initiative utilized the American Heart Association national guidelines for stroke management and current CMS and TJC criteria for the stroke core measures (Appendix B) quality reporting and combined these strategies to create an evidence-based stroke education initiative for APNs. Between November 2017 and February 2018, the SCOPE for APNs was presented at four sites in northern NJ. The participants attended a one-hour educational session that included a pre-test and post-test (Appendix C), and program evaluation (Appendix D). In total, 28 APNs and 27 RNs attended these sessions.

Im Rahmen des Masterstudiums an der ZHAW absolvierte ich ein zweiwöchiges Workshadowing im onkologischen Zentrum "Docrates Cancer Center" und am "Gesundheitszentrum Heitti" in Helsinki. Ziel des Workshadowings war, zu beobachten, wie Advanced Practice Nurses im Gastland ihre Rolle leben, und Impulse für die eigene APN-Rollengestaltung im onkologischen Ambulatorium zu bekommen.

More than 795,000 American adults have a stroke annually. About 610,000 are first or new strokes. Almost 140,000 Americans of all ages die of a stroke every year (Centers for Disease Control and Prevention [CDC], 2017). Stroke requires emergent treatment and an exact clinical order pathway to ensure better patient outcomes and compliance with the standards of care defined by regulatory bodies such as the Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS). While stroke management teams often include an Advanced Practice Nurse (APN), there is a lack of a standardized protocol across New Jersey (NJ) and ambiguity about the role of APNs managing stroke. This quality improvement educational initiative, Stroke Clinical Order Pathways Education (SCOPE) for APNs, was conducted for APNs in NJ to emphasize the importance of the stroke clinical pathway order sets (Appendix A) to improve quality of care for stroke patients and to clearly define the role of APNs. This Doctor of Nursing (DNP) educational initiative utilized the American Heart Association national guidelines for stroke management and current CMS and TJC criteria for the stroke core measures (Appendix B) quality reporting and combined these strategies to create an evidence-based stroke education initiative for APNs. Between November 2017 and February 2018, the SCOPE for APNs was presented at four sites in northern NJ. The participants attended a one-hour educational session that included a pre-test and post-test (Appendix C), and program evaluation (Appendix D). In total, 28 APNs and 27 RNs attended these sessions.

Im Rahmen des Masterstudiums an der ZHAW absolvierte ich ein zweiwöchiges Workshadowing im onkologischen Zentrum "Docrates Cancer Center" und am "Gesundheitszentrum Heitti" in Helsinki. Ziel des Workshadowings war, zu beobachten, wie Advanced Practice Nurses im Gastland ihre Rolle leben, und Impulse für die eigene APN-Rollengestaltung im onkologischen Ambulatorium zu bekommen.

To meet the healthcare demands of an aging population one strategy is the use of advanced practice nurses (APN) in primary care (Buerhaus, DesRoches, Dittus, & Donelan, 2015). Diabetes affects 26.9% of people aged 65 and older in the United States. Mild cognitive impairment (MCI) is often unrecognized in this population (Munshi, Hayes, Iwata, Lee &Weinger, 2012). Information on APN knowledge of this comorbidity or practice characteristics regarding cognitive function assessment is limited. This capstone project sought to increase understanding of APN practice and knowledge of MCI, comparing APNs board certified in advanced diabetes management (BC-ADM) to those without certification. An original measurement tool, created with expert consultation (Cronbach’s α =.810), was sent via a secure web-based questionnaire to a convenience sample of 743 APNs in active adult practice, who were members of the American Association of Diabetes Educators. Response rate was 29% (n=216). Measured outcomes included knowledge scores on a five-item test, and reported frequency and outcomes of cognitive function assessment. Statistical significance was demonstrated between groups for cognitive function assessment at times other than Medicare Annual Well Visits (X2 (2, n=181)=11.34, p=.003, CI 95%. More APNs without BC-ADM certification completed cognitive function assessment than APNs with BC-ADM certification. Overall, knowledge level did not differ between APN groups. Correlations were found between how APNs answered questions related to executive function symptoms (t=2.71, p=< .05), situations indicating unrecognized MCI (t= 2.45, p=.016), and awareness of the ADA Clinical Practice Recommendations (t=2.034, p=.044). Further research and resource development is indicated.

The existence of Almost Perfect Non-linear (APN) permutations operating on an even number of bits has been a long standing open question until Dillon et al., who work for the NSA, provided an example on 6 bits in 2009. In this paper, we apply methods intended to reverse-engineer S-Boxes with unknown structure to this permutation and find a simple decomposition relying on the cube function over GF(2^3) . More precisely, we show that it is a particular case of a permutation structure we introduce, the butterfly. Such butterflies are 2n-bit mappings with two CCZ-equivalent representations: one is a quadratic non-bijective function and one is a degree n+1 permutation. We show that these structures always have differential uniformity at most 4 when n is odd. A particular case of this structure is actually a 3-round Feistel Network with similar differential and linear properties. These functions also share an excellent non-linearity for n=3,5,7. Furthermore, we deduce a bitsliced implementation and significantly reduce the hardware cost of a 6-bit APN permutation using this decomposition, thus simplifying the use of such a permutation as building block for a cryptographic primitive.

The existence of Almost Perfect Non-linear (APN) permutations operating on an even number of bits has been a long standing open question until Dillon et al., who work for the NSA, provided an example on 6 bits in 2009. In this paper, we apply methods intended to reverse-engineer S-Boxes with unknown structure to this permutation and find a simple decomposition relying on the cube function over GF(2^3) . More precisely, we show that it is a particular case of a permutation structure we introduce, the butterfly. Such butterflies are 2n-bit mappings with two CCZ-equivalent representations: one is a quadratic non-bijective function and one is a degree n+1 permutation. We show that these structures always have differential uniformity at most 4 when n is odd. A particular case of this structure is actually a 3-round Feistel Network with similar differential and linear properties. These functions also share an excellent non-linearity for n=3,5,7. Furthermore, we deduce a bitsliced implementation and significantly reduce the hardware cost of a 6-bit APN permutation using this decomposition, thus simplifying the use of such a permutation as building block for a cryptographic primitive.

Over the past half-century, the nursing profession has made great strides in terms of professionalization, status, and compensation. The pervasive focus on coordination and quality of health care in recent health care reform continues to stress effective partnerships between nurses and physicians. However, implicit and often gendered notions of professional authority continue to create barriers to effective communication between nurses and physicians. Relying on interviews and extended observations, this brief reports findings of an in-depth study of nurse-physician interactions in a California hospital. The research has direct implications for the job satisfaction and retention of nurses. The findings also highlight how subtle power dynamics limit the potential of promising organizational change initiatives in the wake of healthcare reform.

Over the past half-century, the nursing profession has made great strides in terms of professionalization, status, and compensation. The pervasive focus on coordination and quality of health care in recent health care reform continues to stress effective partnerships between nurses and physicians. However, implicit and often gendered notions of professional authority continue to create barriers to effective communication between nurses and physicians. Relying on interviews and extended observations, this brief reports findings of an in-depth study of nurse-physician interactions in a California hospital. The research has direct implications for the job satisfaction and retention of nurses. The findings also highlight how subtle power dynamics limit the potential of promising organizational change initiatives in the wake of healthcare reform.

Bacillus thuringiensis subsp. israelensis (Bti) is widely used for the biological control of mosquito populations. However, the mechanism of Bti toxins is still not fully understood. To further elucidate the mechanism of Bti toxins, we developed an Aedes aegypti resistant strain that shows high-level resistance to Cry11Aa toxin. After 27 selections with Cry11Aa toxin, the larvae showed a 124-fold resistance ratio for Cry11Aa (strain G30). G30 larvae showed cross-resistance to Cry4Aa (66-fold resistance), less to Cry4Ba (13-fold), but not to Cry11Ba (2-fold). Midguts from these resistant larvae did not show detectable difference in the processing of the Cry11Aa toxin compared to that in susceptible larvae (WT). Brush border membrane vesicles (BBMV) from resistant larvae bound slightly less Cry11Aa compared to WT BBMV. To identify potential proteins associated with Cry11A resistance, not only transcript changes in the larval midgut were analyzed using Illumina sequencing and qPCR, but alterations of previously identified receptor proteins were investigated using immunoblots. The transcripts of 375 genes were significantly increased and those of 208 genes were down regulated in the resistant larvae midgut compared to the WT. None of the transcripts for previously identified receptors of Cry11Aa (Aedes cadherin, ALP1, APN1, and APN2) were altered in these analyses. The genes for the identified functional receptors in resistant larvae midgut did not contain any mutation in their sequences nor was there any change in their transcript expression levels compared to WT. However, ALP proteins were expressed at reduced levels (∼ 40%) in the resistant strain BBMV. APN proteins and their activity were also slightly reduced in resistance strain. The transcript levels of ALPs (AAEL013330 and AAEL015070) and APNs (AAEL008158, AAEL008162) were significantly reduced. These results strongly suggest that ALPs and APNs could be associated with Cry11Aa resistance in Ae. aegypti.

Aquest treball fi de carrera està basat en l'estudi dels mòduls de telemetria MT-101 i MT-703, subministrats per l'empresa SignalixData, i en el desenvolupament de varis exemples de prestacions que el mòdul MT-101 pot oferir. El mòdul MT-101 consta de tres blocs funcionals bàsics, que es poden classificar en: entrades/sortides, processat i comunicació. Es desenvolupen varis exemples de programació lògica per al tractament de les entrades i sortides, i es presenta un manual bàsic per tal d'implementar dos possibles tipus de comunicació del mòdul: GPRS i GSM. El desenvolupament de l'aplicació GPRS es realitza mitjançant la implementació d'un conjunt servidor-client OPC. L'aplicació GSM s'utilitza per a la comunicació amb el format SMS. També s'ha estudiat la viabilitat tècnica d'integrar el MT-101 en un sistema de vigilància meteorològica, instal.lat en una planta nuclear. En aquest treball es realitza una breu introducció de les característiques del mòdul MT-703 amb l'objectiu d'obrir futures línies de treball.