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jeskey m.,card e.,nelson d.,mercaldo n.d.,sanders n.,higgins m.s.,shi y.,michaels d.&miller A. (2011) Journal of Nursing Management19, 863–875 Nurse adoption of continuous patient monitoring on acute post-surgical units: managing technology implementation Aim To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units. Background Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed. Method Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process. Results Significant differences were identified in night- and dayshift nurses’ perceptions of technology benefits. Research nurses’ facilitated the change process by evolving ‘clinical nurse implementation specialist’ expertise. Conclusions Health information technology (HIT)-related patient outcomes are mediated through nurses’ acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations. Implications for Nursing Management It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units.

The emotion understanding of children with language impairment (LI) was examined in two studies employing emotion-recognition tasks selected to minimize reliance on language skills. Participants consisted of 43 children with LI and 43 typically developing, age-matched peers, sampled from the age ranges of 5 to 8 and 9 to 12 years. In the first study, participants were shown photographs of faces (Matsumoto & Ekman, 1988) and asked to indicate what emotion was being expressed. In the second study, participants listened to excerpts of classical music and indicated what emotion was being expressed. Children with LI identified the facial expressions of happiness, anger, sadness, and fear with the same accuracy as typical children. They were significantly less accurate than their peers at identifying surprise and disgust. Age differences were observed on anger and surprise, with the younger group performing more poorly than the older group. Children with LI also showed significant differences from typical children in identifying the emotion expressed in music excerpts. Significant differences between the performances of the younger and older groups were also found.

In 2015, during my president-elect year, I appointed a task force to investigate chemical employment in the U.S. We invited input from ACS officials, students, and members—both employed and unemployed—from different demographic backgrounds. I detailed the composition and charge of the task force in an earlier Comment (CE (2) many

With the new Trump Administration entering office, conventional political wisdom is changing, and it is still too early to know exactly what that means. Nevertheless, many scientists are asking what the implications for science will be as a result of the changes in Washington, D.C. What will ACS’s priorities be, and how will the society interact with the new Administration? President-elect Trump has been appointing his cabinet, and he is reportedly seeking counsel, studying areas of concern, and evaluating various ideas in making his decisions. The President-elect has shown that he changes his mind about people, policies, and ideas, so initial or previous discussions about topics should not be considered final. The above activities do little to clarify his positions or thoughts on science. On Dec. 1, 2016, ACS hosted the webinar, “Looking into the Crystal Ball: Government, Politics, and the Chemistry Enterprise.” Although we cannot know future science policy

Changes in curriculum are often called innovations, in reference to ideas of progressive improvement. For this study, a group of practitioners in the USA conducted action research about curriculum changes in their elementary and secondary schools. Journals and classroom projects were collected and reviewed. Briefly, we found models of curriculum change that were more cyclical than linear. In this report, we discuss some ideas underlying these models and indicate some contrasting implications of these differing approaches to curriculum change.

Being a member of ACS is one of the best professional investments a chemist can make, often opening doors to opportunities. Like me, many members may recall being told, when they were students, “If you want to be a REAL chemist, you must join ACS.” Although it was decades ago, the words were spoken so emphatically that I still hear them today, and I give students the same message. In fact, most of us, as chemists, can’t imagine a professional life without ACS. It is in members’ best interests that ACS remains healthy and strong. To ensure a bright future for the society, we regularly update the goals of the ACS Strategic Plan, which focuses on members. ACS must also ensure the financial strength of the organization, information technology (IT) security for ACS publication platforms, an adequate number of ACS members, and career development for ACS staff. It may be

Continuously monitoring vital signs on general care units may provide earlier detection and intervention of instabilities in patients. These earlier interventions could prevent deaths and admission to critical care units, thereby increasing patient safety and improving patient outcomes.

Recruiting for research studies is always a challenge, particularly in paediatric studies. Here we report on experiences recruiting children to five studies through primary care.The Scottish Primary Care Research Network (SPCRN) has approval to identify for research studies eligible participants on primary care practice lists. The number of potential participants and the proportion recruited onto five paediatric studies are provided along with factors involved in recruiting practices and patients.A total of 4910 individuals were recruited, of whom 367 (7%) participated. Recruitment of practices varied between 7 and 44% for different studies. There was evidence that practices who had participated in previous studies were more likely to participate again. Patient participation was positively related to affluence and there was evidence that adults were more likely to participate than children.Despite the pressing clinical workload in primary care, many general practices are still able to make accommodation for research activity. What is required is effective communication between colleagues in primary care, researchers, the SPCRN and patients. Given that the majority of medicine is practiced in primary care, there is a desire for evidence-based medicine to be generated from primary care and the SPCRN and other networks can help to provide this.

To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units.Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed.Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process.Significant differences were identified in night- and dayshift nurses' perceptions of technology benefits. Research nurses' facilitated the change process by evolving 'clinical nurse implementation specialist' expertise.Health information technology (HIT)-related patient outcomes are mediated through nurses' acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations.It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units.

To determine the relationship among helmet use, alcohol use, and ethnicity in people killed on motorcycles.Retrospective review of all motorcycle fatalities in New Mexico from 1984 through 1988.Office of the Medical Investigator, State of New Mexico.All decedents of motorcycle crashes in New Mexico from 1984 through 1988.Review of all autopsies, medical investigator reports, traffic fatality reports, and toxicological studies on fatally injured motorcyclists.Nine of the helmeted drivers (18%) were legally intoxicated compared with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42 of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and none of the Native-American decedents were wearing helmets. The head and neck region was the most severely injured body region in 42 of the nonhelmeted cases (84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less than .02).There is an association between nonuse of helmets and alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies for preventing motorcycle fatalities should address alcohol abuse and ethnicity in conjunction with helmet use.

I was scheduled to visit Paris just one week after the deadly Nov. 13 attacks. My plan was to stop on the way back from a conference in Morocco to see members of the French chemistry community. Because of the dreadful events in Paris, it seemed more crucial to meet with them and offer my support, even though the French borders had been closed. So I refused to omit the Paris portion of my trip. While in Morocco, I had been attending the conference “Malta VII, Frontiers of Science: Research & Education in the Middle East, a Bridge to Peace.” This biennial gathering convened scientists from 15 countries representing the Middle East and Morocco and for many provided their only opportunity to exchange scientific ideas, build collaborations and international partnerships, and discuss common problems in the region. The conference mood and discussions, juxtaposed with the news from Paris, confused expectations: ...

This chapter, from a handbook on transportation systems and traffic control, presents a discussion on route guidance systems. After first defining route guidance and its many alternative forms, the authors next discuss stand-alone systems, including Internet-based systems and dispatching systems. A discussion on in-vehicle systems follows, in which the authors look at operator-assisted route guidance, autonomous route guidance, and dynamic route guidance systems, as well as discussing the benefits of in-vehicle systems. The authors conclude with a look at the future of route guidance.

Introduction: Delirium is an acute brain organ dysfunction characterized by altered consciousness, inattention, disorganized thinking, and perceptual disturbances. New-onset delirium has been implicated as primary reason for 10-15% of hospital admissions with 10-30% of inpatients over 65 years old experience some delirium. Recent investigations indicate delirium’s association with worse clinical outcomes (greater costs, length of stay, mortality, and long-term cognitive impairment). Research Problem: Little data exists about emergence and post anesthesia care unit (PACU) delirium. Emergence delirium generally described as agitation upon awakening from anesthesia, prior studies haven’t utilized validated delirium assessment tools, likely missing hypoactive delirium. Purpose of the Study: To study the incidence and risk factors of emergence and PACU delirium in postoperative patients using validated delirium assessment tool (the CAM-ICU). Methods: Prospective observational study of adult PACU patients. Investigator PACU nurses were trained in delirium monitoring. Exclusion criteria: baseline dementia, anoxic brain-injury, neuromuscular disorders, deaf/non-English speaking. CAM-ICU at PACU admission, 30 min, 1 hour, and discharge. Perioperative data collected: demographics, surgery-type, anesthetic length, and medications. Emergence delirium: agitated emergence or positive CAM-ICU upon PACU admission. PACU delirium: positive CAM-ICU at any other time point. Multivariable logistic regression performed to evaluate association of a priori defined risk factors with emergence or PACU delirium. Results: Four hundred postoperative patients studied with a median age of 57 and median ASA classification: 3. Emergence delirium present in 154 (38%) patients [agitated emergence75 (19%) and positive CAM-ICU upon PACU admission124 (33%)]. PACU delirium present in 67 (17%) patients overall [59 (15%), 32 (8%), and 15 (5%) at 30 min, 60 min, and PACU discharge, respectively]. Anesthetic duration and opioid administration were found to be independently associated with emergence delirium, whereas total perioperative opioid administration was independently associated with PACU delirium. Additional risk factors studied didn’t have significant associations with either emergence or PACU delirium. Conclusion: Emergence and PACU delirium are common postoperatively. Anesthetic duration and opioid usage are associated with delirium. Further research needed to confirm these findings and to identify additional risk factors for emergence and PACU delirium, PACU nurses can be pivotal in recognizing and treating delirium. WHAT IMMEDIATE POST-OPERATIVE NURSING CARE CONTRIBUTES TO A BETTER PATIENT OUTCOME AFTER A CHILD HAS HAD A DAY SURGERY TONSILLECTOMY AND ADENOIDECTOMY (T&A)? Primary Investigator: Kristen Kenney, BSN, RN, CPN Boston Children’s Hospital, Boston, MA Co-Investigator: Rhonda Gropman, BSN, RN, CPN

Current theories of stratification in plural societies emphasize the cultural and social homogeneity of the major sections in these societies. Data collected on the Asian population in Kenya, however, suggest that a major section in this plural society is fragmented into a number of different communities. No institutional framework exists which effectively cuts across communal boundaries. Moreover, the nature of the social divisions within the various Asian communities in Kenya, as elsewhere in East Africa, favors the rise of leaders from the upper strata only, i.e., persons of high caste or high economic status or both.