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243 Background: Leadership identified an unhealthy work environment existed in our Oncology Hematology Special Care Unit (OHSCU). This was evidenced by increased turnover, low National Database of Nursing Quality Indicators (NDNQI), and nurse sensitive quality indicator scores. In the fall of 2014 changes were made to the unit with a goal of creating within the unit a culture of clinical excellence, engagement, professionalism, accountability, and improve staff satisfaction. Methods: Leadership met to define the future state of the unit and develop a vision statement. The Quality Manager met with our Unit based Council (UBC) to review data, discuss shared accountability between leadership, and staff and the impact each individual can have on culture and clinical outcomes. Organizational Development facilitated staff focus groups without unit leadership present. Questions asked included: What behaviors would you like to see more or less of? What is your role in supporting change? Focus group results were shared with staff, and guided the development of an OHSCU Guidelines for Professional Behavior. Leadership met with lead staff nurses to discuss their willingness to embrace cultural change and unit vision. Leads completed the Crucial Conversations Class to help them provide immediate, direct, and specific feedback to staff. Leadership met with each staff member to review the guidelines and discuss their commitment to support change. The unit vision was incorporated in all written and verbal communication with staff. Changes in leadership behaviors included increased leadership presence on nights and weekends, daily rounding with patients and staff, and increased amount of positive feedback. Results: Fall injury scores were decreased from 1.55 to 0.25 per 1,000 patient days, target of 0.72. OHSCU has had no catheter associated urinary tract infections (CAUTI) or pressure ulcers in the last 17 months. Patient satisfaction scores have consistently improved over the last nine months. Response of hospital staff scores have increased from 53.6 to 70.9 and currently 90% of patients rate the hospital as a 9 or 10. Conclusions: Through focused efforts and thoughtful actions, it is possible to change the culture of a unit and have a positive impact on quality metrics.

The trilobite fauna of the upper Katian (mid-Ashgill in terms of Anglo-Welsh chronostratigraphy) Oriel Brook Formation in the Grangegeeth Terrane, eastern Ireland comprises 16 species. It is dominated numerically by mesopelagic cyclopygids (Cyclopyge cf. marginata Hawle and Corda and much rarer Symphysops sp.), which comprise 63% of the 156 identifiable sclerites known unequivocally from the formation. Other elements of the trilobite fauna include species of Staurocephalus, Phillipsinella, Nankinolithus and the agnostids Trinodus and Sphaeragnostus. The abundance of cyclopygids in a terrane interpreted as lying within the Iapetus Ocean closer to Laurentia than the Anglo-Welsh sector of Avalonia is consistent with the Late Katian spread of cyclopygids onto low latitude shelves seen in Quebec and Maine in eastern North America, Girvan in SE Scotland and Co. Clare in the Irish Central Terrane. With the exception of the agnostid trilobites, whose mode of life is strongly debated, associated benthic trilobites lacking eyes are fairly rare and the bottom-dwelling fauna does not conform to the atheloptic assemblages that typified many mid- to high latitude Ordovician outer shelf and upper slope settings. The benthic assemblage can be considered in terms of a bathymetrically arranged spectrum of faunas and is closest to that of the deep shelf Phillipsinella parabola—Staurocephalus clavifrons fauna, known from the Upper Ordovician of Avalonia and Baltica and to some extent marginal Gondwana and South China. This is the first record of such a fauna from Laurentia or its marginal terranes and reflects the Late Ordovician breakdown of provincialism in the Iapetus Ocean. The deep-water setting is compatible with that of the associated Foliomena brachiopod fauna.

Objective Preimplantation factor (PIF) is a novel, 15 amino acid peptide, secreted by viable embryos. This study aims to elucidate PIF's effects in human endometrial stromal cells (HESC) decidualized by estrogen and progestin, which mimics the preimplantation milieu, and in first-trimester decidua cultures (FTDC). Study Design HESC or FTDC were incubated with 100 nmol/L synthetic PIF or vehicle control. Global gene expression was analyzed using microarray and pathway analysis. Proteins were analyzed using quantitative mass spectrometry, and PIF binding by protein array. Results Gene and proteomic analysis demonstrate that PIF affects immune, adhesion, and apoptotic pathways. Significant up-regulation in HESC (fold change) include: nuclear factor-k-β activation via interleukin-1 receptor-associated kinase binding protein 1 (53); Toll-like receptor 5 (9); FK506 binding protein 15, 133kDa protein (2.3); and Down syndrome cell adhesion molecule like 1 (16). B-cell lymphoma protein 2 was down-regulated in HESC (21.1) and FTDC (27.1). Protein array demonstrates PIF interaction with intracellular targets insulin-degrading enzyme and beta-K + channels. Conclusion PIF displays essential multitargeted effects, of regulating immunity, promoting embryo-decidual adhesion, and regulating adaptive apoptotic processes.

With little action from Congress, increasingly states and national groups are addressing the uninsured crisis. Last week California became the latest to join the cause, with a bold plan from Gov. Arnold Schwarzenegger. "It's very clear that substantial movement on healthcare insurance is in the air and in the news," says Richard Cauchi, left, of the National Conference of State Legislatures.

Modern Healthcare's fifth annual listing of the 100 Most Powerful People in Healthcare spotlights executives, providers and other insiders who have their fingers on the pulse of the biggest industry trends, such as electronic health records, health savings accounts and rising numbers of uninsured patients. Who's the most influential person in healthcare? One hint: It's not the president.

The head of a small hospital system in South Carolina thought there was something wrong with Hill-Rom's pricing policies. Now that system and some 3,000 other hospitals await a hearing this week on the proposed dollar 337.5 million class-action settlement reached with the bedmaker. Patrick de Maynadier, left, of Hill-Rom, says his company has discontinued the "bundling" practices contested in the lawsuit.

Even as the number of the uninsured has grown to 46 million, the percentage of doctors providing free care has dropped by 8 points since 1996-97. The increasing pressures on physicians are cited as among the reasons. "It's got to do with a lot of things going on with their practices--insurance costs, the reimbursement rate, high overhead", says Linda Kinney, left, of Project Access.

Linda Magno of the CMS says the Medicare Health Care Quality Demonstration project is one of the agency's boldest initiatives yet. She says the project is a chance for providers to "redesign the healthcare system." The project will feature "a lot of latitude" in payment and waivers of Medicare provisions. And the CMS needs a few good volunteer providers to participate.

"Surge" hospitals, which can handle an influx of patients during a large-scale disaster, are being considered by some who think the healthcare industry's plans for such catastrophes need work, says Jim Bentley, left, senior vice president for strategic policy planning of the American Hospital Association.

Modem Healthcare's fourth annual ranking of the 100 Most Powerful People in Healthcare boasts an eclectic group. Those who practice medicine and teach it to others share the list with presidents of companies and the president of the country. Lawmakers and information technology risk-takers round out a roster that mirrors the industry's diversity and highlights the many ways people contribute to healthcare.

The National Practitioner Data Bank was born in 1990, touted as an authoritative way to track doctors whose privileges were suspended. Initial predictions expected up to 10,000 reports yearly, but only about 10,800 reports have been made in 15 years. Many believe hospitals skirt the system by just issuing lesser punishments. "It happens," admits Mark Pincus, right, the databank administrator.