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The study aim was to determine if a targeted redesign of shared decision making improved shared governance (SG).Nursing SG is collaborative decision making between nurses at every level; it improves quality of care, empowers nurses, and enhances nurse satisfaction.Using a quasi-experimental, pretest/posttest design, researchers electronically distributed the Index of Professional Nursing Governance (IPNG) to an inclusive, convenience sample of RNs in a Magnet®-designated 377-bed community medical center. Preintervention scores were used to tailor a redesign of shared decision making, and postintervention data were collected within 1 year to measure outcomes.IPNG overall score and 5 of 6 subscale scores significantly increased after the redesign.Changes to an SG structure can take 2 to 5 years to be realized. Our findings corroborate that the IPNG is a valuable tool in promoting setting-specific SG.

A 35-year-old woman with a history of substance abuse and a seizure disorder presented to the emergency department with altered mental status. According to her family, she was behaving oddly for the past several days, including standing and staring throughout the day, not speaking and resisting

“Chirp”-style sidescan sonar systems, which use pulse-compressed signals, provide advantages over pulsed continuous-wave sidescan sonar systems, including increased imaging range, resolution, and image fidelity. Marine Sonics (Yorktown, VA) has recently released a system, the “Arc Scout”, using modern electronics in a form factor suitable for installation on small autonomous underwater vehicles (AUVs). A number of these systems have been integrated into REMUS 100 AUVs, and their performance imaging archaeological targets on the seabed has been evaluated. Targets were surveyed under a variety of conditions at four different sonar center frequencies: 600 kHz, 900 kHz, 1200 kHz, and 1800 kHz. The results were analyzed to provide performance assessments for selecting the sonar operating characteristics based on area search rate and target size. The hardware and software integration required for the retrofit installation of these sonar systems the REMUS 100 vehicle is detailed.

Objective To evaluate the costs of using dextrose gel as a primary treatment for neonatal hypoglycemia in the first 48 hours after birth compared with standard care. Study design We used a decision tree to model overall costs, including those specific to hypoglycemia monitoring and treatment and those related to the infant's length of stay in the postnatal ward or neonatal intensive care unit, comparing the use of dextrose gel for treatment of neonatal hypoglycemia with placebo, using data from the Sugar Babies randomized trial. Sensitivity analyses assessed the impact of dextrose gel cost, neonatal intensive care cost, cesarean delivery rate, and costs of glucose monitoring. Results In the primary analysis, treating neonatal hypoglycemia using dextrose gel had an overall cost of NZ$6863.81 and standard care (placebo) cost NZ$8178.25; a saving of NZ$1314.44 per infant treated. Sensitivity analyses showed that dextrose gel remained cost saving with wide variations in dextrose gel costs, neonatal intensive care unit costs, cesarean delivery rates, and costs of monitoring. Conclusions Use of buccal dextrose gel reduces hospital costs for management of neonatal hypoglycemia. Because it is also noninvasive, well tolerated, safe, and associated with improved breastfeeding, buccal dextrose gel should be routinely used for initial treatment of neonatal hypoglycemia. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12608000623392.

Background: Professional nursing governance refers to the processes and structures that influence nursing practice within an organisation. This study measured the effect of structured meeting communication processes on nurses' perceptions of professional governance. Method: The intervention was implemented in eight hospital wards. After 3 months, nurses on the intervention wards and eight matched-control wards completed the Index of Professional Nursing Governance (N = 225). Data were compared with a sample of Magnet (R) (N = 3) and non-Magnet (N = 46) hospitals. Results: There was substantial variation in nurses' perceptions of governance across the 16 wards, irrespective of the intervention. Compared to non-Magnet hospitals, the overall score and three of the six subscales scores were higher in this study. Magnet hospitals scores, however, were typically higher suggesting greater progress towards shared governance. Conclusions: Professional nursing governance can be highly variable across individual wards and tailored interventions should be considered. Refereed/Peer-reviewed

The objective of this study was to examine RNs' experiences with health information technology (HIT) and their perceptions of the effect of this technology on quality of care and daily work. The adoption and use of HIT are expected to increase substantially over the next 5 years because of policy efforts at the federal and state levels. Given the size of the RN workforce and their critical role in healthcare delivery, their experiences with HIT could help adoption efforts. The method used was a nationally representative survey of 1500 nurses with a 56% response rate. Findings suggest wide variation in the availability of HIT functionality, with functions more likely available to hospital RNs. Overall, RNs perceived the effect of these technologies on quality of care and their daily work as positive. Ensuring that HIT systems are relevant to and usable for RNs will be a critical component in achieving the meaningful use of these systems.

When we graduated from veterinary school, we thought homework would finally end. Little did we know that even after we became full-fledged veterinarians, homework would never end. Veterinary medicine is constantly evolving. Because new medical treatments and surgeries are constantly being developed in all fields of veterinary medicine, it is our responsibility, even our obligation, to ourselves, our clients, and our patients to keep abreast of these developments. Making time and resources available to obtain continuing education (CE) can be challenging given the demands of our work and families. In veterinary school, new information was spoon-fed to us in a classroom. But as graduate veterinarians, we have to actively join organizations, spend hard-earned salaries, and often travel long distances to obtain CE. We also must be knowledgeable of CE requirements demanded by the various states in which we practice and by the various specialty colleges to which many of us belong.Veterinarians handle CE in different ways. Some look forward to CE; others dread it. To address this issue, I invited 6 practitioners working in different states to comment on their feelings and approaches to CE. The participants are William Benner, MS, DVM, VCA South Hadley Animal Hospital, South Hadley, MA, USA; Kenneth D. Dazen, VMD, Dipl ABVP (Avian Practice), Animal and Bird Health Care Center, Cherry Hill, NJ, USA; Robert Hess, Jr, DVM, Winter Park Veterinary Hospital, Winter Park, FL, USA; Michael Lutz, DVM, West Meade Veterinary Clinic, LLC, Nashville, TN, USA; Robert Ness, DVM, Ness Exotic Wellness Center, Lisle, IL, USA; and Rhoda Stevenson, DVM, Dipl ABVP (Avian Practice), Exotic Bird Hospital, Jacksonville, FL, USA. I hope this discussion will make you aware not only of how your colleagues approach CE but also of how you think about CE, so that you can stay on top of new developments in veterinary medicine.

Aim To determine the accuracy of caregivers’ recall of hospital admissions in early childhood. Methods Prospective cohort study of babies born at risk of neonatal hypoglycaemia at Waikato Hospital, New Zealand, a regional public hospital and sole provider of acute inpatient care to over 100,000 children. Caregivers’ recall of children's hospital admissions up to 4.5 years was compared with medical records. Accuracy of recall was related to neonatal and socio-demographic characteristics. Results Of 267 children, 179 (67%) visited hospital and 106 (40%) were admitted at least once. The most frequent reasons for admission were for respiratory (29%) and gastrointestinal (18%) problems. Of 106 children admitted to hospital, 27 (25%) caregivers did not recall the admission and only 37 (35%) accurately recalled the number of admissions. The accuracy of recall was lower for gastrointestinal (38%) and surgical (40%) problems, while recall of respiratory (64%) and ear, nose and throat (60%) admissions was more accurate. Low socio-economic status and multiple admissions were associated with less accurate recall of number of admissions. Conclusion Caregivers do not accurately report hospital admissions. Questionnaire data about use of hospital facilities should be interpreted cautiously and may not be sufficiently accurate for use in research studies.

To determine neurodevelopmental outcome at 2 years' corrected age in children randomized to treatment with dextrose gel or placebo for hypoglycemia soon after birth (The Sugar Babies Study).This was a follow-up study of 184 children with hypoglycemia (2.6 mM [47 mg/dL]) in the first 48 hours and randomized to either dextrose (90/118, 76%) or placebo gel (94/119, 79%). Assessments were performed at Kahikatea House, Hamilton, New Zealand, and included neurologic function and general health (pediatrician assessed), cognitive, language, behavior, and motor skills (Bayley Scales of Infant and Toddler Development, Third Edition), executive function (clinical assessment and Behaviour Rating Inventory of Executive Function-Preschool Edition), and vision (clinical examination and global motion perception). Coprimary outcomes were neurosensory impairment (cognitive, language or motor score below -1 SD or cerebral palsy or blind or deaf) and processing difficulty (executive function or global motion perception worse than 1.5 SD from the mean). Statistical tests were two sided with 5% significance level.Mean (± SD) birth weight was 3093 ± 803 g and mean gestation was 37.7 ± 1.6 weeks. Sixty-six children (36%) had neurosensory impairment (1 severe, 6 moderate, 59 mild) with similar rates in both groups (dextrose 38% vs placebo 34%, relative risk 1.11, 95% CI 0.75-1.63). Processing difficulty also was similar between groups (dextrose 10% vs placebo 18%, relative risk 0.52, 95% CI 0.23-1.15).Dextrose gel is safe for the treatment of neonatal hypoglycemia, but neurosensory impairment is common among these children.Australian New Zealand Clinical Trials Registry: ACTRN 12608000623392.

Elubiol (dichlorophenyl imidazoldioxolan) is used as a cosmetic ingredient for the conditioning of oily skin. It was found in controlled and open clinical trials to control sebum output effectively at the skin surface. In vitro testing has indicated a potential of reducing cholesterol biosynthesis, thus modulating the lipid composition of sebum; of antimicrobial activity against organisms associated with dandruff or seborrhea; and of scavenging free radicals. Elubiol is well tolerated and no systemic toxicity is observed on dermal application. There is no evidence of sensitization potential in vivo, nor of specific irritancy or phototoxicity in vitro. A standard battery of tests revealed no genotoxic potential. Topical Elubiol hardly penetrates into the epidermis and there is no evidence that percutaneous absorption occurs, as confirmed by studies in animals and humans. In the absence of systemic exposure, Elubiol is considered to be a safe ingredient for cosmetic use.

Based on the published literature, the assessment of nonclinical and clinical data on retinol indicates absence of any systemic effects after topical or cosmetic use. Hypervitaminosis A that may be...

Overuse and abuse of phenacetin-containing mixed analgesics has contributed to end-stage renal disease. Combination analgesics, especially those coformulated with caffeine, have been implicated as imparting a greater risk of analgesic-associated nephropathy (AAN) than single or coformulated analgesics without caffeine. This has led to a recommendation that the sale of "two plus caffeine" analgesic mixtures be reclassified from over-the-counter to prescription only availability. There is a rational basis for coformulating acetylsalicylic acid (ASA) and acetaminophen (paracetamol) as this reduces the dose of each, without altering efficacy. The coformulation of caffeine with these analgesics has a significant adjuvant effect and increases analgesic efficacy 1.4-1.6-fold. Currently available animal and human data do not support the notion that the nephrotoxic risk from coformulated ASA and acetaminophen is higher than the risk from either ASA or acetaminophen alone, in equivalent analgesic doses. There are no epidemiological data that implicate caffeine in AAN, and only limited evidence that links excessive acetaminophen usage to renal disease. There is no evidence that caffeine increases analgesics papillotoxicity directly. The presence of caffeine in mixtures of analgesics are no more addictive than other sources of caffeine. There is no evidence to suggest that adding caffeine to analgesic mixtures enhances the potential for promoting analgesic misuse in the general population. Thus distinct therapeutic benefits of ASA, acetaminophen and caffeine appear to outweigh any known risk. It is doubtful if preventing the availability of these products will significantly affect the role of analgesic abuse/overuse in end-stage renal disease. Better risk management would come from a focused educational program, developed in a close collaboration between industry, healthcare professionals and consumer organizations, such a program must warn against the potential dangers of analgesic and non-steroidal anti-inflammatory drug misuse.

This paper presents the findings of a field study and performance analysis of a solar thermal cooling system located in Phoenix, Arizona. This system is compared to conventional air conditioning equipment, as well as conventional air conditioning equipment powered by solar electric (photovoltaics). The design of the solar cooling system, which incorporates solar-generated hot water and a single-stage absorption chiller, is discussed. Capital and maintenance cost estimates, including auxiliary electric load and water, are also provided. Operational problems are reviewed together with the design modifications that were required to resolve these issues. Performance of the system and the individual components was determined based on field data collected. Using this data the solar cooler energy savings over conventional air conditioning equipment was determined (Figure 1).Copyright © 2010 by ASME

This paper presents a framework for the development of advanced video conferencing systems with very high quality. The design and performance of the developed components like session management, real-time scheduler and a specific transport system are outlined. The core of the framework consists of a toolkit for the processing of audio and video data. It integrates capturing, compression, transmission and presentation of media streams into an object oriented class library. The specifics of audio/video hardware, preferred operation modes, compression algorithms and transport protocol properties are encapsulated. Due to the achieved abstraction level complex application software can easily be developed resulting in very short design cycles. Contrary to existing systems the developed application is regarded in its entirety. The focus on highest possible performance throughout all components is unique to our approach. Due to a number of optimisations, specific compression hardware is not required which leads to low overall system costs.

The use of software codecs for video compression becomes commonplace in several videoconferencing applications. In order to reduce conflicts with other applications used at the same time, mechanisms for resource reservation on endsystems need to determine an upper bound for computing time used by the codec. This leads to the demand for predictable execution times of compression/decompression. Since compression schemes as H.261 inherently depend on the motion contained in the video, an adaptive admission control is required. This paper presents a data driven approach based on dynamical reduction of the number of processed macroblocks in peak situations. Besides the absolute speed is a point of interest. The question, whether and how software compression of high quality video is feasible on today's desktop computers, is examined.

Background Despite outcomes studies measuring such variables as job satisfaction, autonomy, professionalism, turnover, leadership styles, and more recently, cost-effectiveness, no consistent relationships have been established between shared governance models and outcomes. Objectives To define and develop an instrument to measure the governance of hospital-based nurses. Methods The 88-item Index of Professional Nursing Governance (IPNG) was developed to measure professional nursing governance of hospital-based nurses. Psychometric properties were tested with 1,162 registered nurses from 10 hospitals. Results Content validity after item generation was .95, using Popham's average congruency procedure. Six factors explained 42% of the variance with subscale intercorrelations between .43 and .67. All subscales had a high degree of internal consistency (alphas .87 to .91); test-retest reliability was .77. Construct validity testing showed that scores between shared governance and traditionally governed hospitals were significantly different. A correlation was found between scores on the IPNG and the Hague and Aiken Index of Centralization. Conclusions The results of this study support the validity of the 88-item IPNG as a reliable instrument for measuring the distribution of professional nursing governance of hospitals.

A rising number of video conferencing applications uses software codecs for video compression. This allows to support several compression schemes without the necessity for expensive dedicated hardware for every new standard. Using inexpensive framegrabber boards, it is possible to support several different compression schemes as H.261 or H.263. But the computing power of today's desktop system does usually not allow for the simultaneous compression and decompression of high quality video. One solution is to equip these systems with dedicated hardware, trading off the above mentioned flexibility and introducing considerable costs per machine. This paper presents an approach for the distributed compression of live video, exploiting cheap LAN capacity and thus dividing the compression process into a short preprocessing on the desktop and a second stage performing the more complex operations on a dedicated compression server, that may be shared by a workgroup or even more people.

Today's networks are characterized by heterogeneous environments. Various transmission techniques coexist and offer different bandwidths at different costs. For example, it is possible to transmit 155 Mbps and more with the Asynchronous Transfer Mode (ATM). As opposed to that, most LANs are based on Ethernet links, which allow only a 10 Mbps transfer rate. The major problem of multimedia communication systems is the lack of resource reservation protocols such as RSVP in current practical environments. Scaling of media streams is a current possibility and trade-off to meet the needs of the end user, to prevent the waste of bandwidth and to react onto phases of low available bandwidth.

P= angle-of-sideslip, deg a(.) =deflection of (-) control surface, deg be = roll and pitch angles, respectively, deg R = attitude angles, deg w = angular rates, deglsec With the increasing complexity of today's high performance aircraft, there exists a strong need to provide accurate aircraft simulations. The Navy, through efforts conducted at the Naval Air Test Center (NAVAIRTESTCEN), is developing the most accurate FIA-18A & B aerodynamic models possible. Flight data collected from both the single seat (F/A-18A) and two seat (TF-18A or F/A-18B) fighter-escort (FE) configurations has been analyzed using modern parameter identification (PID) methodologies. The goal of this analysis has been to validate and improve the NAVAIRTESTCEN F-18 aerodynamic simulation database u sing m odern s ystems i dentification techniques. Presented in this paper is a description of the NAVAIRTESTCEN FIA-18A & B simulations, a brief discussion of the flight test and data analysis methods used, a sample of the results obtained and conclusions drawn from this work. Subscripted variables ol the form C~(.), Cm(.), C D (.I, CL (-1, CY (.) denote partial derivative of coefficient with respect to (.).

Publisher Summary This chapter discusses the evaluation of drugs active against experimental atherosclerosis. Atherosclerosis is generally accepted to be a disorder of lipid metabolism. When dealing with complex pathogenic entities such as atherogenesis, it is important, though difficult, to separate causal factors from symptoms. One of the main questions in this regard centers around the role of hyperlipidemia in the etiology and pathogenesis of the various forms of chronic arterial disease. Control of blood lipid levels is now one of the main goals of therapeutic research, and, as pointed out by Steinberg, it has to be achieved to designate hyperlipidemia as a determining factor in the genesis of human atherosclerosis. The simplest way of keeping blood lipid levels low would be to alter drastically present dietary habits and to encourage physical exercise. Ingestion of highly unsaturated fatty acids supplemented to an ordinary diet has the effect of increasing lipid absorption. Alteration of plasma lipoprotein composition by heparin has not been proven to be of therapeutic value.