Core Elements Research Articles

An Update From the National Healthcare Safety Network on Hospital Antibiotic Stewardship Programs in the United States, 2014-2021.

In 2014, the Centers for Disease Control and Prevention (CDC) released the Core Elements of Hospital Antibiotic Stewardship Programs (ASPs) and began monitoring uptake through the National Healthcare Safety Network (NHSN) Annual Hospital Survey. In 2019, CDC updated the Core Elements and in 2022 released the Priorities for Hospital Core Element Implementation. We describe Core Element uptake from 2014 to 2021, provide a snapshot of specific ASP practices in acute care hospitals in 2021, and describe how we plan to monitor stewardship moving forward. We used the NHSN Annual Hospital Survey to summarize facility demographics and ASP practices and to monitor uptake of Core Elements. Questions have been updated over time, so not all data could be compared across years. Uptake of all 7 Core Elements increased from 41% in 2014 to 95% in 2021. Uptake of all 6 Priority Elements was 10% in 2021, though 46% of hospitals met 4 or 5 of the possible 6 elements. Antibiotic stewardship was specifically listed in a contract or job description for about 60% of program leaders. The percentage of physician-pharmacist co-led programs rose from 23% to 64%. Seventy-six percent of hospitals reported implementing audit with feedback interventions. With nearly all acute care hospitals reporting uptake of the 7 Core Elements in 2021, and with more evidence for which ASP practices are most effective, the Priorities for Hospital Core Element Implementation were released in 2022 to help enhance the quality and impact of existing ASPs.

The US Student Antisweatshop Movement's Presence and Success at the Campus Level: Impacts of Collective Identity Strength and Network Density1

College students and campuses have played key roles in social movements because colleges' cultural and structural features tend to facilitate movements. But such attributes vary across campuses. This quantitative study models how two campus features that correspond to core elements of social movement theory—students' collective identity strength and social network density—appear to impact United Students Against Sweatshops (USAS) groups' presence and success on 1,265 US 4‐year public and private nonprofit campuses during 2000–2006, operationalizing success as schools' joining the Worker Rights Consortium (WRC) monitoring organization. Results generally indicate that collective identity strength and network density promote USAS presence and that network density facilitates WRC membership. USAS presence is pivotal, though not required, for WRC membership. Our logistic regression models also confirm that campus opportunity structures and off‐campus movement actors' roles help account for these USAS outcomes; notably, antiunion location (“Right‐to‐Work” states) undermines and Roman Catholic school affiliation encourages USAS presence and success. We identify theoretically why certain factors may promote only some forms of student activism (e.g., conscience constituent but not beneficiary‐based groups).

Synthesis of Photography, Art and Neuropsychological Concepts Within Psychoanalytic Psychotherapy: An Illustrated Case Study

The integration of non‐verbal, creative/implicit processes into ongoing psychoanalytic treatment as a highly effective modality to process trauma, also understood as Mentalization as a core element in the correction of pathological thinking caused by trauma (Allen et al., 2008. Mentalizing in clinical practice. Arlington, VA: American Psychiatric Publication) will be presented. This clinical approach is designed to gain access to deeper unconscious, implicit, pre‐verbal memories and material that may have been otherwise inaccessible for clinical processing on a purely verbal level. The author will offer an ongoing case study of a client who was initially resistant to direct verbal processing of traumatic memories. He will then demonstrate how the communication of implicit stimuli, in the form of photographs and drawings, can be structured as the primary initial communication of non‐verbal material within this treatment. Images were presented by the patient at the beginning of each virtual session, allowed her to access traumatic material without triggering overwhelming anxiety allowing adequate affect regulation and enabling successful clinical processing of this previously inaccessible material. The author offers, from both a neurological and psychoanalytic perspective, demonstrations of clinical processing and intervention techniques that have, up until now, been utilized within the clinical fields of creative art therapy and psychoanalysis on an intuitive level without having a firmer foundation in demonstrable neuroscience. It is the intended purpose of this article to bridge this gap between previous intuitive interventions and neuroscientific research, within our clinical work.

Investigating the Underlying Factors and Outcomes of the Madheshi People's Movement in Nepal (2007-2008)

The study focuses on the Madheshi People’s Movements in the Tarai region of Nepal during 2007 and 2008. The key issues investigated include the catalysts behind these movements, their influence on Nepalese politics, and the sustained implications for Madheshis and other marginalized communities. The primary aim of this research is to discern the causes of the Madheshi People’s Movements, understand their impact on Nepalese politics, and evaluate the lasting effects of the achievements stemming from these uprisings. Utilizing semi-structured interviews, Focus Group Discussions (FGD), questionnaire surveys, and an extensive review of secondary data, the research unfolds the transformative nature of the Madheshi People’s Movement of 2007. The methods employed provide a comprehensive understanding of the socio-political landscape surrounding these movements. The research identifies three core elements contributing to the initiation of the 2007 and 2008 Movements: perceived discrimination against Madheshis, radicalization of regional and ethnic issues influenced by the Maoist rebellion, and the precedent set by the People’s Movement of 2006. The Madheshi People’s Movements significantly impacted Nepalese politics, leading to the declaration of Nepal as a federal state and notable electoral success for Madheshi political parties. However, internal divisions emerged within the Madheshi identity, with marginalized communities distancing themselves from the Madheshi label, posing a potential threat to the movements' achievements. While the Madheshi People’s Movements brought about crucial changes in Nepal's political landscape, the emergence of internal dissent among Madheshis calls for a strategic repositioning of Madheshi political parties. To preserve their achievements, these parties must transcend identity boundaries and represent the interests of all marginalized communities in Nepal. Failure to do so risks eroding the gains made through the identity politics initiated by the Madheshi parties.

Towards a standardized program of transitional care for adolescents with juvenile idiopathic arthritis for Turkey: a national survey study

BackgroundJuvenile idiopathic arthritis (JIA) is a prevalent childhood chronic arthritis, often persisting into adulthood. Effective transitional care becomes crucial as these patients transition from pediatric to adult healthcare systems. Despite the concept of transitional care being recognized, its real-world implementation remains inadequately explored. This study aims to evaluate the thoughts and practices of healthcare providers regarding transitional care for JIA patients.MethodsA cross-sectional survey was conducted among pediatric and adult rheumatologists in Turkey. Based on the American Academy of Pediatrics’ six core elements of transitional care, the survey included 86 questions. The respondents’ demographic data, attitudes towards transitional care, and practical implementation were assessed.ResultsThe survey included 48 rheumatologists, with 43.7% having a transition clinic. The main barriers to establishing transition programs were the absence of adult rheumatologists, lack of time, and financial constraints. Only 23.8% had a multidisciplinary team for transition care. Participants agreed on the importance of coordination and cooperation between pediatric and adult healthcare services. The timing of the transition process varied, with no consensus on when to initiate or complete it. Participants advocated for validated questionnaires adapted to local conditions to assess transition readiness.ConclusionsThe study sheds light on the challenges and perspectives surrounding transitional care for JIA patients in Turkey. Despite recognized needs and intentions, practical implementation remains limited due to various barriers. Cultural factors and resource constraints affect the transition process. While acknowledging the existing shortcomings, the research serves as a ground for further efforts to improve transitional care and ensure better outcomes for JIA patients transitioning into adulthood.

Taksonomijos reglamento įtaka aplinkosauginiams mokesčiams Lietuvoje

From being an object of scientific discussions climate change has found its way to our everyday lives. It has become an inevitable driver for political decisions. On December 11, 2019 the European Union presented its Green Deal, an action plan to attain sustainable development goals as adopted by the UN General Assembly on September 25, 2015, and in the Paris climate agreement. The EU seeks to become climate-neutral by 2050. A core element of the Green Deal is a system for sustainable finance for climate-friendly economic activities. A common vocabulary is needed in order to eveluate the scope of such economic activities, to balance the input of private and public bodies, and to ensure a fair competition for the investments. Such a vocabulary, also known as Taxonomy, is presented by the Regulation (EU) 2020/852 of the European Parliament and of the Council. It introduces labels and criteria that allow to identify and compare economic activities in the light of sustainability. Eventhough the Taxonomy regulation is a legal act of direct application, it manages to introduce norms into the laws passed by the Lithuanian Parliament. The duty to disclose information on the environmental sustainability of economic activities and investment products comes into force in 2023. Seeking to transform the markets, tax cuts are introduced for economic activities that are in line with the environmental goals. This article unfolds the concept of Taxonomy as well as its impact on investment and tax legislation in Lithuania.

Assessment of Adherence to the Core Elements of Hospital Antimicrobial Stewardship Programs: A Survey of Fourteen Hospitals in Nigeria

Introduction Antimicrobial resistance occurs when antimicrobial drugs are no longer effective against the target microorganism and this poses a global public health threat especially in low and middle-income countries (LMICs), including Nigeria. This study aimed to assess hospitals core elements AMS implementation in 14 secondary and tertiary hospitals in Nigeria. Methods Centre for Initiative and Development (CFID) in collaboration with the Nigeria Centre for Disease Control (NCDC), employed cross-sectional intervention study across 14 target hospitals in Nigeria. The study adopted the WHO Core Elements Hospital AMS self-assessment tool. Paired-samples t-test was used and a p-value less than 0.05 was considered as statistically significance. Results Results from the baseline assessment revealed inadequate implementation of AMS programs in most hospitals, emphasizing key deficiencies in areas such as leadership commitment, tracking antibiotic use, and reporting outcomes. However, following CFID AMS intervention, a significant positive shift in performance of hospitals AMS core elements was observed, with hospitals showing improvements in leadership commitment, accountability, and prescriber education. The paired-samples t-test demonstrated a statistically significant decrease in the measured variable, reinforcing the impact of the intervention and a substantial increase in mean scores of post-intervention. Conclusions It is imperative to acknowledge the potential implications of these positive shifts, not only in the context of individual hospitals but also in the broader landscape of public health. Addressing the challenges identified in this study is crucial for mitigating the global public health threat posed by antimicrobial resistance, particularly in resource-constrained settings. Future research and continued collaborative efforts will be essential to sustain and further improve the effectiveness of AMS interventions, ultimately contributing to the global effort to combat antimicrobial resistance.

EFEKTIFITAS E-KATALOG PADA KEGIATAN PENGADAAN BARANG DAN JASA (PBJ) DALAM UPAYA PEMERINTAH MENCEGAH FRAUD

Government Procurement of Goods and Services (PBJ) through e-purchasing with e-catalog is expected to be as a more reliable method for PBJ officer, specifically for Commitment-making officer (PPK) and Procurement Officer (PP) due to the process has become faster and easier to choose between providers, as well as all transaction recorded in the LKPP e-catalog and therefore the process is transparent in nature. Procurement method with e-catalog expected can prevent fraud or human error. This study uses juridical normative approach by going through reference book, regulations, and related literature. Results of this research proof that Procurement of Government Goods and Services through e-katalog, has benefit in term of clarity, speed of the process and the simplicity, however in term of fraud resistance there is still loophole in the system. Through e-catalog prices can be see by anyone, selection process and also all transaction are recorded in the LKPP e-catalog therefore transparent in nature. However, price set in the LKPP e-catalogue are the highest in the government, therefore PP still has to negotiate the price.

Simultaneous determination of Cd, Pb, Cu and Zn as total and labile fractions in soil using a small-sized electrothermal vaporization capacitively coupled plasma microtorch optical emission spectrometer after diffusive gradients in thin-film passive accumulation

A sensitive and free interference method for the determination of total and labile fractions of Cd, Pb, Cu and Zn in soil after DGT passive accumulation and detection by optical emission spectrometry with an Ar microplasma was validated.

Software testing and release decision at different statistical confidence levels with consideration of debuggers’ learning and negligent factors

This research delves into the software testing process and its environmental factors to uncover the core elements influencing software reliability. Specifically, it focuses on the learning and negligent aspects of the software reliability growth model. The learning factor accelerates reliability growth, leading to an S-shaped curve in the mean value function, while the negligent factor highlights the occurrence of imperfect debugging. The study also uses Brownian motion and stochastic differential equations to establish statistical confidence intervals for reliability and costs. These intervals aid software managers in assessing potential release risks at various confidence levels, allowing them to make informed decisions considering resource constraints and desired system reliability levels across different scenarios.

Enhancing Agile team productivity with metrics

Article explores the significance of Agile methodologies and their role in enhancing the efficiency of Agile teams through the utilization of metrics. It underscores the importance of visualizing the workflow, establishing Work in Progress (WIP) limits, and promoting a culture of ongoing improvement within Agile settings. The fundamental principles of Kanban, which encompass the visualization of work, WIP limitation, focus on flow, and continuous improvement, form the foundation of the approach discussed in the article. The concept of «Flow» is highlighted as a core element of Agile methodologies, signifying the uninterrupted progression of work items through the development pipeline. Flow metrics provide valuable insights into the well-being and progress of Agile teams. The article also delves into practical strategies for implementing these metrics, addressing common challenges such as bottlenecks and distractions. Additionally, it introduces Cumulative Flow Diagrams (CFDs) as visual tools for comprehending work distribution and identifying workflow inefficiencies. In the dynamic landscape of Agile, this article serves as a roadmap for harnessing the potential of metrics to continually enhance the effectiveness of Agile teams, enabling the precise and consistent delivery of value.

Study on the Path of Cultivating Rural Teachers under the Perspective of Rural Revitalization---Taking the Cultivation of Directed Teacher Trainees in Jiangsu Province as an Example

Abstract This study delves into the training of rural teachers, a core element of rural education revitalization. Focusing on the training of oriented rural teacher trainees and their willingness to arrive, this paper adopts a combination of structural equation modeling and double-stranded quantum genetic algorithm to deepen the understanding of influence pathways. The method successfully obtains a broader range of feasible solutions by introducing different prior knowledge. In this study, the improved structural equation modeling (SEM) was applied among oriented teacher trainees of different grades in six universities in Jiangsu Province, parameter estimation tests were conducted through SmartPLS, key indicator variables were established and empirical data were obtained through research. The results showed that teachers’ professional identity significantly positively affected the attitude of performance arrival, with a critical ratio value of 3.3469 and a substantial value of the unstandardized coefficient (P<0.001). In addition, it was found that the performance-to-post attitudes of the oriented teacher trainees were positively influenced by the satisfaction with the rural teacher job offerings. This study provides an essential decision-making basis for constructing a good training environment for oriented teacher trainees, which is of great significance for promoting the revitalization of rural education.

Defining Key Elements of a Clinical Experience in Hospice and Palliative Medicine for Medical Residents in the United States.

Training in hospice and palliative medicine (HPM) is essential for practicing internists, who routinely care for patients and families facing serious illness. Program directors and medical residents acknowledge the importance of palliative medicine skills, and trainees themselves desire more such training. The ACGME has also recognized the importance of HPM training for medical residents, establishing in its 2022 Common Program Requirements for Internal Medicine a new expectation that all residents have a clinical experience in HPM. However, internal medicine residencies vary significantly in their approach to teaching HPM skills, and what constitutes a useful clinical experience in HPM has not been well-described. In this perspective, we draw from the available literature and our experience as educators to propose 5 core elements for creating an optimal HPM experience for medical residents. These include practice with symptom management and communication in serious illness, exposure to interdisciplinary care, appreciation of the continuum of care settings for HPM delivery, and an understanding of the key principles of hospice care. We then describe the relevance of each element and offer educational strategies regarding how each can be achieved.

The Development of an Advanced Model for Multilayer Human Skin Reconstruction In Vivo.

Human skin reconstruction on immune-deficient mice has become indispensable for in vivo studies performed in basic research and translational laboratories. Further advancements in making sustainable, prolonged skin equivalents to study new therapeutic interventions rely on reproducible models utilizing patient-derived cells and natural three-dimensional culture conditions mimicking the structure of living skin. Here, we present a novel step-by-step protocol for grafting human skin cells onto immunocompromised mice that requires low starting cell numbers, which is essential when primary patient cells are limited for modeling skin conditions. The core elements of our method are the sequential transplantation of fibroblasts followed by keratinocytes seeded into a fibrin-based hydrogel in a silicone chamber. We optimized the fibrin gel formulation, timing for gel polymerization in vivo, cell culture conditions, and seeding density to make a robust and efficient grafting protocol. Using this approach, we can successfully engraft as few as 1.0 × 106 fresh and 2.0 × 106 frozen-then-thawed keratinocytes per 1.4 cm2 of the wound area. Additionally, it was concluded that a successful layer-by-layer engraftment of skin cells in vivo could be obtained without labor-intensive and costly methodologies such as bioprinting or engineering complex skin equivalents. Key features • Expands upon the conventional skin chamber assay method (Wang et al., 2000) to generate high-quality skin grafts using a minimal number of cultured skin cells. • The proposed approach allows the use of frozen-then-thawed keratinocytes and fibroblasts in surgical procedures. • This system holds promise for evaluating the functionality of skin cells derived from induced pluripotent stem cells and replicating various skin phenotypes. • The entire process, from thawing skin cells to establishing the graft, requires 54 days. Graphical overview.

THE HUMAN DIMENSION OF SUSTAINABLE DEVELOPMENT IN THE PERSPECTIVE OF OCCUPATIONAL SAFETY AND HEALTH

The aim of this study is to examine the "Decent Work and Economic Growth" section of the United Nations' (2015) "Agenda 2030: UN Sustainable Development Goals" from the perspective of occupational safety and health. Decent work consists of various dimensions, but this study specifically focuses on the aspect of occupational safety and health. While there are studies in the literature that evaluate sustainable development from the standpoint of occupational safety and health, it is crucial to investigate the topic from a human perspective, taking into account the International Labor Organization's goal of decent work. This is because the core element of working life is the human being, and sustainable development cannot be achieved without a focus on humanity. Therefore, research in this direction underscores the significance of the study. In the analysis of this study, data obtained by the International Labor Organization from various countries on the fundamental indicators of occupational safety and health have been categorized, tabulated, and evaluated, considering the World Bank's country classifications by income groups. In conclusion, there are challenges in accessing accurate data, especially in the field of occupational safety and health worldwide. Furthermore, there is a long way to go in terms of the human dimension of sustainable development resulting from occupational accidents and diseases.

How culture builds nations: the power of symbolism over nation-building

Nationalism studies differ in terms of approaches to the subject. Various opinions on a given topic focuses on different aspects of nationalism, its core elements, and causal links between ends, ways, and means. This paper focuses on culture, arguably one of the most influential dimensions among other layers constituting and shaping nationalism among different nations. In doing so, it considers Anthony Smith’s explanation of national identity, which, according to the latter, is shaped by a fundamental consensus among the population on things like culture, religion, history, language, ethnicity, political values, and norms of behaviour and aims and other related notions. The causal link between nation and culture is revealed by making a holistic account of different sub-elements of culture like memories and narratives; language, poetry, and art; national folklore and symbols; social norms, traditions, etc, in different historical eras and seeing their role in a nation-building process. The paper also focuses on a modern-day example, an ongoing conflict between Russia and Ukraine that has exceeded the boundaries of a mere military domain and is also visible from a cultural perspective. The paper’s main finding is identifying elements affecting nation-building and making it work. While all these different elements of culture were, are, and will be used in the future in a nation- building process, perception remains a vital factor. Culture and its elements can certainly significantly impact nation-building. However, in the end, it will always depend on how individuals, communities, and populations perceive national symbols, the historic heroic deeds of their ancestors, poems and literature, and norms of social behaviour and traditions. Without socially constructing these perceptions, the “us vs them” narrative might not materialize.

An Integrative Review of Psychosocial Intervention Programs for Infertile Females

Background: This study aims to analyze intervention studies conducted on infertile females in South Korea and research and research the core elements comprising these studies.Methods: The integrative review was conducted based on the guidelines of Whittmore and Knafl, and included the following steps: problem identification, literature search, data evaluation, data analysis, and presentation. Next, six domestic databases were searched using keywords such as ‘infertility’, ‘intervention’, and ‘education’ in Korean and English, and published studies were reviewed according to specific criteria and quality assessment.Results: Among 4,109 searched papers, 6 were selected for the final data analysis. A total of six interventions were conducted in the selected articles, and each strategy was variously categorized into cognitive, emotional, behavioral, relational, and physical aspects. All interventions were found to be effective in promoting psychosocial health in infertile females.Conclusions: Despite the fact that female infertility is a major public health problem in Korea, the low number of articles reveals a relative lack of psychosocial intervention studies. Therefore, it is suggested that future studies incorporate physiological endpoints into psychosocial studies, and we hope that this study will serve as a basis for developing programs for infertile females in the future.

Exploration of Core Competencies from Delphi Survey and Design of Their Measurement Tools and Teaching & Learning Programs for Environmental Education in Elementary Schools

This study aims to establish core competencies for environmental education in elementary schools, develop its measurement tools, and explore program grouping methods. To address these goals, three research questions were posed: identifying core competency elements, determining their assessment tools, and exploring the best ways to organize environmental education programs to develop the core competencies. Using a Delphi survey and literature review, the research pinpointed core elements such as 'autonomy', 'reflective ability', 'environmental sensitivity', and 'critical thinking ability', among others. Based on these competencies, 34 assessment items were devised. To enhance these competencies, a 'theme integration method' was proposed, intertwining environmental education with other curriculum topics. The study emphasizes the importance of an integrated approach, ensuring students grasp environmental subjects while achieving other learning objectives. Consequently, the measurement tools and learning & teaching programs for environmental education in elementary schools presented in this study assist teachers in customizing environmental topics based on regional, school, and individual teaching goals, rooted in the intended core competencies.

디지털 리터러시가 디지털 전환 태도에 미치는 영향

This article focuses on the discussion of digital transformation, a topic of global interest, aiming to empirically analyze the factors necessary for its desirable acceptance by individuals in society. Considering digital technology as a core element of digital transformation, we hypothesize that digital literacy - the ability to operate digital devices and use them for intended purposes - significantly influences an individual’s attitude towards digital transformation. Additionally, we propose that the level of life satisfaction from digital transformation could mediate the relationship between digital literacy and their attitude towards it. To test these hypotheses, we utilize raw data from the “2022 Digital Divide Survey” conducted by the Korea Intelligence and Information Society Agency. We analyze the research model based on the mediation effect model verification method proposed by Baron & Kenny (1986). The results show that an individual's level of digital literacy positively influences their attitude towards digital transformation, and the level of life satisfaction due to digital transformation mediates about 64% of the total effect of digital literacy on this attitude. Consequently, this study suggests policy implications for successfully integrating digital transformation into our society. It emphasizes the need to develop policy alternatives that consider factors related to digital transformation at the individual level, the importance of enhancing national digital literacy, and prioritizing the development and dissemination of digital transformation services that citizens can tangibly experience in their daily lives.

ESG 경영 강화 수단으로서 디자인의 잠재성 고찰

In recent years, as interest in ESG has increased, companies have been expanding their investments and efforts to strengthen their ESG management. This study aimed to explore the possibilities and benefits of utilizing the design field as a practice methodology to strengthen ESG management. To this end, this study theoretically examined the connection between ESG and design through a literature review and also investigated and analyzed the use of design for ESG practices through a case study. The results showed that design and ESG management have common core elements of environment (E) and society (S), and they work in a way that considers environmental and social impacts or implements environmental and social responsibility to achieve the purpose of pursuing sustainability and social value. This study showed that design is a powerful practice that can enhance ESG management and provide new perspectives and approaches for companies to contribute to society through environmental and social problem solving. In particular, sustainable design and social problem-solving design are clear practices in the environmental (E) and social (S) dimensions of ESG that can be expected to produce tangible results.