Daily Staff Research Articles

Increased serum EGF but not SDF-1 levels are associated with the pathophysiology and development of generalized anxiety disorder

Generalized anxiety disorder (GAD) is a common and persistent mental illness accompanied by uncontrollable worries for daily staff. Physiological, environmental, genetic, and daily stress from surroundings is involved in developing GAD. Here, we aimed to assess the association of stromal cell-derived factor-1 (SDF-1) and epidermal growth factor (EGF) in the pathophysiology of GAD and their role as diagnostic tools. This case-control study recruited 50 GAD patients from the psychiatry department of a tertiary care teaching hospital in Dhaka city and 38 age-sex-matched healthy controls (HCs) from the surrounding areas. A qualified psychiatrist conducted standardized psychiatric interview to diagnose GAD patients and evaluate HCs by applying the diagnostic and statistical manual for mental disorders, 5th edition (DSM-5) and used the GAD-7 scale to assess the severity of the GAD symptoms. After confirming the inclusion and exclusion criteria, we collected 5 ml blood samples from each participant. We measured serum SDF-1 and EGF levels using ELISA techniques. We observed increased serum levels of EGF in GAD patients compared to HCs (5.91 ± 3.90 ng/ml vs. 1.59 ± 1.08 ng/ml; p < 0.001). Also, this increment is positively associated with the severity of GAD in patients (r = 0.479, p = 0.002). The receiver operating characteristic analysis showed good diagnostic performance (AUC 0.869, p < 0.001) with high sensitivity (82.5%), and specificity (81.1%) at cut off value of 2.31 ng/ml. However, we didn’t find significant differences in serum SDF-1 levels between GAD patients and HCs (11.96 ± 4.50 ng/ml vs. 12.70 ± 11.76 ng/ml; p = 0.337). The present study suggests that GAD patients have increased serum EGF levels but not SDF-1 levels compared to HCs and that increased EGF levels are associated with increased GAD symptoms as well. Moreover, EGF levels could serve as a biomarker for GAD However, further interventional studies with larger and homogeneous samples are suggested to confirm and establish these findings.

1998 Advance care planning on the Same Day Emergency Care Older People's Unit - a quality improvement initiative

Abstract Introduction Same Day Emergency Care (SDEC) at St James’ Hospital, Leeds provides urgent care at the interface between primary and secondary care, offering comprehensive geriatric assessment (CGA) to those living with frailty, aiming to prevent hospitalisation and delay frailty progression. Advance care planning (ACP) is a vital component of prioritising care preferences including at end-of-life, but timing often falls short in practice. This quality improvement (QI) initiative aims to proactively open ACP discussions, allowing patients to consider their care goals, ensuring our care is aligned with their priorities. Method Between July 2022 and April 2023, the project involved 1039 patients. Led by Advanced Clinical Practitioners with support from consultant geriatricians and a palliative care specialist nurse, ACP discussions were encouraged through prompts in daily staff huddles and drop-in teaching sessions. Results ACP uptake increased from 7.8 % to 19.3%. Insights from a perception survey involving 83 healthcare professionals revealed key barriers including clinical workload, limited space, lack of experience and confidence as well as prognostic uncertainty and patient factors. Education and training, clinical supervision, patient information leaflets and a conducive environment were positively associated with ACP. Conclusion There has been a cultural shift in the department as the practitioners now routinely prompt staff to undertake ACP in safety huddles. Key catalysts for ACP initiation were found to be progression of frailty, terminal diagnoses, dementia, and recurrent hospital admissions. As a new SDEC unit is scheduled to open in the coming months, with provision of space and privacy, our aim is to improve the quality and quantity of ACP discussions with the patient at the centre of all decision-making. In line with these endeavours, parallel support within the community through our home (virtual) ward will further enhance proactive care planning in older people living with frailty.

Evaluation of Correctional Facility COVID-19 Outbreaks With Layered Mitigation Strategies Including Vaccination: Colorado, 2020-2021.

In 2020-2021, a Colorado corrections facility experienced four COVID-19 outbreaks. Case counts, attack rates (ARs) in people who are detained or incarcerated (PDI), and mitigation measures used in each outbreak were compared to evaluate effects of combined strategies. Serial PCR testing, isolation/quarantine, and masking were implemented in outbreak 1. Daily staff antigen testing began in outbreak 2. Facility-wide COVID-19 vaccination started in outbreak 3 and coverage increased by the end of outbreak 4 (PDI: <1% to 59%, staff: 27% to 40%). Despite detection of variants of concern, outbreaks 3 and 4 had 97% lower PDI ARs (both 1%) than outbreak 2 (29%). Daily staff testing and increasing vaccination coverage, with other outbreak mitigation strategies, are important to reduce COVID-19 transmission in congregate settings.

Factors affecting the public higher education institution (PHEI) acceptance of online meetings applications during COVID-19 pandemic: an empirical study

PurposeIn order to ensure effectiveness of staff's performance using online meetings applications during coronavirus disease (COVID-19), having the behavioural intention is mandatory for staff to measure, test, and manage the staff's data. Understanding of Public Higher Education Institution (PHEI) staffs' intention and behaviour toward online meetings platforms is needed to develop and implement effective and efficient strategies. The objectives of this paper to identify the factors that affect staff to use online meetings applications, to develop a model that examining the factors that affect PHEI staff to online meetings applications and to validate the proposed model. This study used a cross-sectional quantitative correlational study with using UTAUT2 model by validating the model and mediating variables to enhance the model's explanatory power and to make the model more applicable to PHEI staff's behavioural intention.Design/methodology/approachThe data were collected in Malaysia from March to May 2021. The survey took place using Google form and was send to PHEI staff for answer. This research particularly chooses PHEI as the location to carry out the research due to two main factors. Statistical analysis and hypotheses were tested using structural equation modelling based on the optimisation technique of partial least squares. SmartPLS software, Version 3.0 (Hair et al., 2010) was used to conduct the analysis. A conceptualised estimation model was “drawn in” the partial least squares structural equation modeling (PLS-SEM) to analyse the consequences of the variables' relationships. In essence, the PLS-SEM simulation was carried out in a model by assessing and computing various parameters that included elements like validity, durability, and item loading. Henseler et al. (2009) suggested a two-step method that includes PLS model parameter computing. This is accomplished by first solving the estimation model in the structural model independently before calculating the direction coefficients. The results of data analysis using SmartPLS findings and interpretation of the data are addressed. The questionnaire was extensively examined to ensure that the data obtained were presented in a clear and intelligible manner, with the use of figures, and graphs.FindingsThis current study found that the usability of the material, the reliability of operating, the impact of the PHEI staff's views on its usage, and finally the familiarity with the online meetings platforms influenced PHEI staff's behavioural intention for adoption and long-term use of online meeting platforms using UTAUT2. The staff's behavioural intention for using online meeting platforms was significantly influenced by the effort expectancy, facilitating conditions and habit of online meeting platforms. There was a clear association between “Habit” and “Behavioural Intention” for the usage of information technology in learning in several studies (El-Masri and Tarhini, 2017; Uur and Turan, 2018; Mosunmola et al., 2018; Venkatesh et al., 2003). As a consequence of the utility of online meeting platforms in daily staff meetings and learning activities, this technology has been adopted.Originality/valueThis study used UTAUT2 and structural equations modelling in this study to assess respondents' perspectives on the use of online meetings platforms in PHEI, since users' perspective is a significant factor in the adoption and acceptance of online meeting applications. Staff's behavioural intention to use online meeting platforms was effectively enhanced by “Effort Expectancy,” “Facilitating Conditions” and “Habit” in this study. The study shows that identifying PHEI staff's perspectives will effectively increase the staff's aversion to utilising online meeting platforms for online meetings purposes.

Impact of non-pharmaceutical interventions on SARS-CoV-2 outbreaks in English care homes: a modelling study

BackgroundCOVID-19 outbreaks still occur in English care homes despite the interventions in place.MethodsWe developed a stochastic compartmental model to simulate the spread of SARS-CoV-2 within an English care home. We quantified the outbreak risk with baseline non-pharmaceutical interventions (NPIs) already in place, the role of community prevalence in driving outbreaks, and the relative contribution of all importation routes into a fully susceptible care home. We also considered the potential impact of additional control measures in care homes with and without immunity, namely: increasing staff and resident testing frequency, using lateral flow antigen testing (LFD) tests instead of polymerase chain reaction (PCR), enhancing infection prevention and control (IPC), increasing the proportion of residents isolated, shortening the delay to isolation, improving the effectiveness of isolation, restricting visitors and limiting staff to working in one care home. We additionally present a Shiny application for users to apply this model to their facility of interest, specifying care home, outbreak and intervention characteristics.ResultsThe model suggests that importation of SARS-CoV-2 by staff, from the community, is the main driver of outbreaks, that importation by visitors or from hospitals is rare, and that the past testing strategy (monthly testing of residents and daily testing of staff by PCR) likely provides negligible benefit in preventing outbreaks. Daily staff testing by LFD was 39% (95% 18–55%) effective in preventing outbreaks at 30 days compared to no testing.ConclusionsIncreasing the frequency of testing in staff and enhancing IPC are important to preventing importations to the care home. Further work is needed to understand the impact of vaccination in this population, which is likely to be very effective in preventing outbreaks.

P0096 / #565: THE TRAVAILS OF SETTING UP A LIVING DONOR LIVER TRANSPLANT PROGRAM: THE PICU PERSPECTIVES EXPERIENCE FROM TUNISIA

Aims & Objectives: To report our first experience of PICU care of living donor liver transplant (LDLT) in Tunisia, and the challenges encountered. Methods: This was a retrospective, descriptive study, collecting the first 10 pediatric LDLT at the Fattouma Bourguiba Hospital between November 2017 and March 2019. Results: The patients average age was 5 years and 11 months. The most common indication of LDLT was cirrhosis complicating PFIC. The average duration of mechanical ventilation was 1.8 days. One child developed hepatic artery thrombosis, another patient developed supra hepatic vein thrombosis. 2 patients developed acute rejection treated with immunosuppressant. The PICU length of stay ranged from 4 to 10 days and there was no ICU mortality. Challenges: - The Creation of liver transplant unit, - The Shortage of nursing staff was addressed by the participation of nurses from pediatric and adult ICU while awaiting the recruitment of more nurses, - The lack of experience of nurses in post- LT care necessitated to send few of them to Necker enfant malades to gain exposure to various aspects of LDLT, - The lack of Pediatric intensivist with expertise in LT was alleviated by the collaboration of pediatric intensivist from France. A daily staff by tele medicine guarantees the continuity of follow-up by the 2 teams. Conclusions: This study marks the successful development of a pediatric LT program in Tunisia. In the developing countries PICU care faces unique challenges in developing LDLT programs. Acknowledgements: We thank Christophe Chardot for his efforts and support in the inception of our transplant program

Daily anesthesia assignment schedule automation: Utilizing an electronic scheduling system to export daily assignments into the electronic health record

BackgroundMost anesthesia providers utilize an electronic health record (EHR) during daily interactions with patients. For many anesthesia groups the daily operating room assignments are also made within the EHR. The individual manual entry of providers into the assignment fields within the EHR are time consuming and may be a source for human error and incorrect assignment of personnel. MethodsHere we present a process that allowed our group to automate import of the daily staff assignments from a central scheduling software system into our EHR. We have described the process from both an information technology build standpoint as well as evaluating the improvement of accuracy of scheduling assignments after implementation. ResultsWe evaluated the rate of scheduling optimization, i.e. changes made to clinical assignments subsequent to finalization of schedule at 2pm the workday before the day of surgery, in a cohort of 998 daily OR schedule locations (494 pre- and 504 postimplementation) and found a 13.3% rate of optimization pre implementation versus a 6.9% rate of optimization after implementation. ConclusionThis process of automation saves time, improves ease of making daily assignments, and may have broader applications for improvement in transparency and satisfaction of providers in their assignments.

Web Alert

Sleep Junkies https://sleepjunkies.com/ Description: Sleep Junkies is a free web site with a plethora of sleep-related resources including blogs, podcasts, and articles, authored by a variety of doctors and academics. The articles include everything from summaries on the latest sleep-related science and research to reviews of the latest sleep gadgets and technology. The web site's sections include latest posts, podcasts, sleep resources, sleep research, bedroom setup, and kids- and family-related topics. Of particular interest may be its popular resources that include articles on white noise and sleep and the benefits of sleeping naked. For anyone who has been trying to improve their sleep habits or sleep quality, this web site is a great resource with a wealth of information. Cost: Free Fitness Blender https://www.fitnessblender.com/ Description: Created by personal trainer husband and wife Daniel and Kelli Segars, Fitness Blender is a web site with more than 500 free workout videos for every fitness level. Videos can be searched by duration, calorie burn, difficulty, trainer, body focus, training type, and equipment. The videos are characterized as upper body, lower body, total body, and core. There is a section on healthy living with resources and articles on fitness, health, healthy recipes, and weight loss referenced from scientific literature. There also is a section with before and after testimonials for added motivation. The community section includes user-driven discussions on a variety of topics, and the blog section includes articles and updates from the Fitness Blender community. Cost: Free, workout programs and meal plans are available for a cost. Foodility Available on the iOS app store Description: Foodility is a free simple food and fitness diary by Green Tea Lab Inc. The app supports simple meal logging without calorie counting in addition to exercise, water, and weight logs. Meals are recorded on simple expandable sticky notes. All logged data can be exported to PDF, whereas water and weight logs can be viewed in statistic charts. Data also can be viewed in calendar format to help users better organize their food and fitness goals. The data can be synced between iOS devices while push notifications can be set up as reminders to log meals, water, and/or exercise. The app also provides basic information about restaurants including location, web site, and hours of operation. Cost: Free Insight Timer https://insighttimer.com, Available on the iOS and Android app stores Description: Insight Timer claims to be “the largest free library of guided meditations on earth.” Although also available on iOS and Android mobile app stores, the Insight Timer web site provides a wealth of meditation resources. Its main sections including guided meditation to improve sleep, cope with anxiety, and manage stress in addition to meditation music and meditation for kids. The essential listening section includes highly rated guided meditations and talks, whereas daily staff picks can be a useful way for individuals to get started. Additional sections entitled “Sleep soundly,” “Music for calm,” “Insightful talks,” and “For the kids” include curated meditations and talks. A total of 300 meditation courses also are available to paid members, and there is a free 30-day trial available for users who are considering the paid membership. Teachers from whom the material is derived have a variety of backgrounds from being yoga instructors to gurus and Zen masters. Cost: Free with an optional US $59.99 annual membership for courses. Johnson & Johnson Official 7-Minute Workout Available on the iOS and Android app stores Description: If you have ever had difficulty finding time to exercise, Johnson & Johnson can help. The 7-Minute Workout app contains 22 preset workouts varying in intensity and duration from 7 to 32 min, giving you the ability to fit one into your busy schedule no matter how busy and no matter your fitness level. Users have the ability to customize their workouts by combining the 72 available exercises ranging from easy to hard. Each exercise is accompanied by a video tutorial. Using the Smart Workout tool, the app can gauge a user's fitness and motivation levels to create a variety of user-specific workouts. Additionally, workout and inactivity reminders can help users stick to their plans and accomplish their health and fitness goals. The app is designed by Director of Exercise Physiology Chris Jordan at the Johnson & Johnson Human Performance Institute. If this app interests you, you also may want to check out the article entitled, “High-Intensity Circuit Training Using Body Weight: Maximum Results with Minimal Investment,” also by Chris Jordan and Brett Klika from ACSM's Health & Fitness Journal®: https://bit.ly/2S1eHUt. Cost: Free

Developing a mathematical model for staff routing and scheduling in home health care industries: Genetic Algorithm based solution scheme

Efficient management of providing home health care services requires many considerations. In this paper, a mathematical model for the daily staff routing and service scheduling is developed for home health care companies. In this model, both economic factors and qualitative service-oriented performance measures are simultaneously optimized. To make the model more realistic, many real situations such as considering different qualifications and diverse vehicles for staff members, different requirements and predetermined preferences for patients, possible temporal interdependencies between services, and continuity of care (CoC) are taken into account. We also added some important constraints related to blood sampling requirements, which make our proposed model more complex. The proposed model is a mixed integer linear programming model (MILP) that belongs to an NP-hard class of optimization problems. To solve such a complex mathematical model, a genetic algorithm (GA) is proposed to find near-optimal solutions. We use some randomly generated test instances with different sizes to evaluate the performance of the GA. Finally, it is demonstrated how the proposed solution scheme can end up with proper scheduling and routing policies compared to those obtained through exact methods.

Staff's perception of Patients’ affiliation and control in a Highly Secure Psychiatric Setting

Effective interactions between patients and staff have been associated with positive ward climate and therapeutic effects, but also pose a challenge in high secure forensic psychiatric settings. The goal of this study was to gain more insight into i) the characteristics that play a role in how staff members perceive the interpersonal style of patients, and ii) whether these perceptions are related to patients’ evaluation of ward climate and satisfaction with daily staff. Staff members (n = 69), rated the interpersonal style of 102 male patients. Satisfaction with daily staff and ward climate were rated by 45 patients. Results show that patient characteristics (primary diagnosis, patient age, disruptive behavior, recent problems with symptoms of major mental disorder and recent problems with treatment or supervision response) were related to how staff perceived the interpersonal style (i.e., affiliation and control) of patients. Furthermore, the level of affiliation was positively related to patients’ satisfaction with daily staff. Patients that were seen as more controlling by staff were less satisfied with the safety on their ward (as a factor of ward climate). The results indicate that perception of patients’ interpersonal style entails patient related information and can be relevant for staff to use in their work.

Robotic dispensing improves patient safety, inventory management, and staff satisfaction in an outpatient hospital pharmacy.

Implementation of robotic systems in outpatient hospital pharmacies is uncommon. Other than cost, 1 of the barriers to widespread adoption is the lack of definitive evidence that this technology actually reduces dispensing errors and improves inventory management. To identify the frequency of medication dispensing errors before and after the implementation of a robotic original pack dispensing system in an outpatient hospital pharmacy and to analyse the impact of this system on the quality of stock management and staff satisfaction. A prospective before-and-after medication error study was performed using a disguised observation technique. Several indicators of stock management and staff satisfaction were monitored. Drugs were dispensed manually by technicians using a barcode-controlled system (preimplementation phase) or the dispensing robot ROWA Vmax (ARX) (postimplementation phase). As not all drugs could be handled by the robot, residual manual dispensing was also used. The dispensing error rate was reduced from 1.31% of prescriptions (43/3284) to 0.63% (19/3004) (relative risk reduction [RRR], 51.7%; 95% CI, 17.3% to 71.8%). The error rate decreased up to 0.12% (3/2496) (RRR, 90.8%; 95% CI, 70.4% to 97.1%) if errors during residual manual dispensing were excluded. The stock-out ratio was reduced from 0.85% to 0.17% (RRR, 80.5%; 95% CI, 49.5% to 92.5%). Daily staff time (median) in stock management was reduced by 59.3% (from 1hour 36minutes to 39minutes). High level of staff satisfaction with this technology was achieved, although it was slightly higher in the group of pharmacists compared to technicians (8.63±0.7 vs 7.78±0.7, P=.046). The implementation of a robotic original pack dispensing system substantially decreased the rate of dispensing errors and optimized stock management. Minimizing the number of drugs out of the dispensing robot is critical when attempting to maximize the benefits of its implementation.

The Determinants of Employment of Full-time Jobs at the Corporate Level - Focusing on the distribution of labor income -

본 연구는 기업차원의 상용직 고용 결정요인을 분석하였으며, 분석결과는 다음과 같다. 첫째, 노동소득분배율 변수는 통계적으로 유의한 정(+)의 영향을 미치는 것으로 나타나 노동소득분배율이 높을수록 상용직 고용을 증가시키는 것으로 추정되었다. 영업이익률, 매출액, 연구개발비 변수는 상용직 고용을 유의하게 증가시키는 반면, 자본집약도, 외주가공비, 임시·일용직비율 변수는 고용을 감소시키는 것으로 분석되었다. 인건비 변수는 임금인상이 이뤄진 당해 연도는 상용직 고용을 감소시키는 반면, 그 다음해에는 상용직 고용을 유의하게 증가시켰다. 둘째, 산업(제조업/비제조업), 기업규모(중소기업/대기업), 기술유형(노동집약적/기술집약적)을 구분하여 노동소득분배율이 상용직 고용에 미치는 영향을 추정한 결과, 전반적으로 노동소득분배율이 높을수록 상용직 고용을 유의하게 증가시켰으며, 고용에 미치는 영향력은 각 특성에 따라 약간 달랐다. 따라서 기업차원의 상용직 일자리를 늘리기 위해서는 유의한 정(+)의 영향을 미치는 것으로 분석된 노동소득분배율, 영업이익, 매출액, 연구개발비 변수 등에 대한 정책을 강화할 필요가 있다. 또한 산업, 기업 규모, 기술유형에 따라 고용에 미치는 영향력이 다른 만큼, 이를 고려한 각특성에 맞는 일자리 정책이 요구된다.This study analyzed the determinants of employment at the enterprise level by merging data from the National Statistical Office s Corporate Activity Survey for 10 years (2006 ~ 2015). The results are as follows. First, the labor income distribution variable had a statistically significant positive effect, suggesting that the higher the labor income share rate, the higher the employment of regular workers. While operating margin, sales, and R & D variables significantly increase the employment of regular workers, it is estimated that capital intensity, outsourcing costs, temporary and daily staff ratio variables reduce employment. The labor cost variable decreased the employment of regular workers in the year of wage increase, and significantly increased the employment of regular workers after one year Second, as a result of estimating the impact of the labor income distribution ratio on the employment of regular workers by classifying the industry (manufacturing / non-manufacturing), enterprise size (SME / large enterprise) and technology type (labor intensive / technology intensive) The higher the employment of regular workers. Employment impacts were slightly different for each trait. Therefore, it is necessary to strengthen policies on labor income distribution, operating income, sales, R & D variables, etc., which are analyzed as having a positive(+) influence in order to constantly employ regular job positions at the enterprise level. In addition, employment, which has different impacts on industry, size of enterprise and type of technology, needs a job policy for each characteristic.

PP-34 Adverse drug reactions in neonates: comparing retrospective spontaneous yellow card reports to prospectively collected reports

Background The UK Medicines and Healthcare prod-ucts Regulatory Agency (MHRA) encourages the report-ing of all adverse drug reactions (ADRs) in children that are ‘serious or result in harm’.1 The rate of under-report-ing of ADRs has been estimated to be approximately 94% and neonatal ADR reports are not influencing the clinical warnings issued by the MHRA.2,3 This study aims to compare reports of neonatal ADRs actively collected by a researcher from a tertiary neonatal unit to those reported to the UK yellow card system between 2001 and 2010. Methods An independent researcher collected data on ADRs in a tertiary neonatal care unit by daily ward round attendance, note reviewing and staff questioning. The results collected over four weeks were then compared to the yellow cards submitted to the MHRA between 2001 and 2010 by means of reviewing a recently published paper.3 Results Between 2001 and 2010 there were ninety seven yellow card reports of neonatal ADRs to the MHRA. Over a four week observational period thirty three neonatal ADR cases were suspected and reported by a researcher. The highest number of yellow card reports were for swine flu vaccinations (eight), whereas the researcher only collected one report relating to a vaccine, with the highest number of reports involving diuretics or antibiotics (six each). The yellow card reports most frequently reported rashes or erythema (twenty one) whereas the researcher most frequently reported electrolyte disturbances (seven), car-diac effects (five) or gastrointestinal effects (five). Conclusion There are a number of differences between neonatal ADRs reported to the MHRA and those occur-ring commonly. It is thought the predicted under-report-ing of ADRs and lack of knowledge or attention to neona-tal ADRs may be contributing to this.

A comparative analysis of Center for Independent Living staff and board of directors regarding CIL services and consumer participation

ABSTRACTCommunity living of people with disabilities spans independent living and community engagement. Consumer choice and control of their level of community participation requires community accessibility, resources and supports. Some people with disabilities have difficulties procuring and maintaining these resources. Centers for Independent Living (CIL) are advocacy and service agencies that have been empowering consumers to meet their needs for over 40 years. Despite this history, little is known about the value of CIL services for increasing community participation of people with disabilities. We administered the CIL Participation Service Survey to 420 CIL staff members and 107 CIL board members to examine their opinions about the relative value of different CIL services for increasing community participation of their consumers. Results indicated that both staff and board members have very high regard for the value and quality of CIL services. The Independent Living (IL) philosophy of consumer choice and control was among the most highly rated aspects of CIL service delivery for both staff and board members. Overall, staff and board member responses were very consistent in terms of the top-rated strengths and weaknesses of CIL services for increasing participation among consumers. Differences appeared to reflect the daily staff focus on specific consumer need versus board members’ view of larger community issues.

Organization Design: Linking Mind to Its Agreed Organization Role as a Foundation of Economics

Organization design is a new aspect of organization study that has arisen due linking the organization to individual psychology and the direct link it enables between daily staff behaviour to organization strategy, which in turn is linked to the national economy. Traditional global best practice of HR and organizational development does not achieve that link, or does so due only fortunate accident. Thus organization design refers specifically to the scientific details of the solution to the first Ashby equation in linking the daily activity of a person to the national economy, SHRMsuccess→ organization success. Should the person deliver to standard the actions identified in the organization design link, then that person can be said to have ‘done their bit’ in contributing to the organization achieving its strategy (refer to Why Work for further discussion).I suggest the term organization design be a restricted very precise term referring specifically to the foundation issue of identifying the scientifically valid direct and clear link between a mind and the strategy of the business. I suggest this because of the significance of this link as a foundation of western democracy free market economics. This paper outlines the organization design system OPD-HCD™ as a foundation of economics; how it works, why it is important, its role in micro- and macro-economics, how it is implemented, and the payback in financial gains and staff satisfaction to be expected. OPD-HCD™ is the only system of organization design available globally. Given the depth of intellectual foundation of OPD-HCD™, it is difficult to imagine that the link between individual mind and the organization strategy can be constructed in any other way.

Integrating Lean Six Sigma in the daily operations of an ICU to achieve safe, quality patient care.

230 Background: Developing and maintaining a culture of safety and quality in delivering patient care is critical in the intensive care unit (ICU) especially an oncology ICU. Incorporating the Lean Six Sigma program into daily operations of the ICU achieves, simplifies, and sustains continuous improvement in the delivery of safe quality patient care. This program engages the ICU team through visual management of quality, safety, and budget indicators including medication scanning, falls, sharps exposure, infection prevention including blood stream, catheter, hospital and ventilator acquired pneumonias, venous embolism prevention, and staffing compliance. Methods: The initiative focused on stakeholder development to increase professional certifications, improve engagement through development and implementation of educational events, and enhance participation in monthly journal club. Discussion of evidence-based research projects aligned each shift with data, metrics, and outcomes. Cost containment through charge capture, reduction in wasted supplies, and appropriate level of care order was implemented. With the support of Lean Six Sigma, the lean daily management board came to life each shift. Results: Outcomes included medication scanning rates increasing from 94% to 99.5%. Hospital acquired infection and pressure ulcer rates remained 0%. Venous thromboembolism prophylaxis rates increased form 77% to 100%. Staffing compliance increased from 90% to 100%. The number of chemotherapy certified nurses increased from 56% to 71%. The number of nurses with specialty certification improved from 28% to 47%. Stakeholders engaged in 32 professional educational events, and 12 journal clubs were led by the ICU nurses. Product charge capture began at $0 ending in an average of $1342 per month from 0% charge capture to 100% charge capture each month. Conclusions: Team alignment around daily production, patient flow, and staff development enables real-time problem solving around the daily issues of safety, quality, productivity, and stakeholder development. In this oncology critical care unit it has not only enhanced daily communication but every twelve hour shift engagement as well.

Toward a Model of Camp Staff Engagement: A Look at University-Based Day Camps

Camp staff who feel engaged in their work are more likely to gain a variety of beneficial outcomes as well as create quality experiences for the campers they serve. Engagement, which is fundamentally situational, can be described both as a state of being fully present and as an overall sense of deep connection to the given context. While many models explaining engagement and its antecedents exist, most represent either an educational setting or a traditional work setting; neither of which may accurately apply to college-age camp staff. The camp setting may provide unique intersections between work and school for staff members and is a promising environment to explore camp staff engagement. The purpose of this study was to understand day camp staff engagement both as a day-to-day state of being fully present as well as staff members’ larger sense of deep connection to their day camp staff jobs. The guiding question was “What do engaged staff say, feel, and do?”; secondary questions explored staff members’ perceptions of the factors that affect or prevent engagement in their jobs. A total of 38 staff members from two university-based day camps that are of comparable size and program focus participated in this study. Data were collected using daily staff journals and focus groups. Daily staff journals were used to examine the day-to-day nature of engagement, and focus groups were used to explore engagement more broadly and to understand what factors impede and foster staff to optimally engage in their work at camp. Activation, participation, and connection with campers and peers were three dominant themes that described what engaged staff say, feel, and do in their jobs. For the participants of this study, physical and emotional wellness, stress, and connection were the three primary factors that either supported or prevented engagement. These results suggest that university-based day camp staff engage in ways that are different from how existing models imply they might engage in non-camp jobs or in college. This study takes a needed first step toward developing an operational model of camp staff engagement and offers important considerations for camp managers in university as well as other recreation-based day camp settings who hire college students, students soon to be enrolled in college, or recent graduates as frontline day camp staff.

Leveraging Multiple Artificial Intelligence Techniques to Improve the Responsiveness in Operations Planning: ASPEN for Orbital Express

The challenging timeline for DARPA's Orbital Express mission demanded a flexible, responsive, and (above all) safe approach to mission planning. Mission planning for space is challenging because of the mixture of goals and constraints. Every space mission tries to squeeze all of the capacity possible out of the spacecraft. For Orbital Express, this means performing as many experiments as possible, while still keeping the spacecraft safe. Keeping the spacecraft safe can be very challenging because we need to maintain the correct thermal environment (or batteries might freeze), we need to avoid pointing cameras and sensitive sensors at the sun, we need to keep the spacecraft batteries charged, and we need to keep the two spacecraft from colliding … made more difficult as only one of the spacecraft had thrusters.Because the mission was a technology demonstration, pertinent planning information was learned during actual mission execution. For example, we didn't know for certain how long it would take to transfer propellant from one spacecraft to the other, although this was a primary mission goal. The only way to find out was to perform the task and monitor how long it actually took. This information led to amendments to procedures, which led to changes in the mission plan. In general, we used the ASPEN planner scheduler to generate and validate the mission plans. ASPEN is a planning system that allows us to enter all of the spacecraft constraints, the resources, the communications windows, and our objectives. ASPEN then could automatically plan our day. We enhanced ASPEN to enable it to reason about uncertainty. We also developed a model generator that would read the text of a procedure and translate it into an ASPEN model. Note that a model is the input to ASPEN that describes constraints, resources, and activities. These technologies had a significant impact on the success of the Orbital Express mission. Finally, we formulated a technique for converting procedural information to declarative information by transforming procedures into models of hierarchical task networks (HTNs). The impact of this effort on the mission was a significant reduction in (1) the execution time of the mission, (2) the daily staff required to produce plans, and (3) planning errors. Not a single misconfigured command was sent during operations.

Inside a Chinese Communist Municipal Newspaper: Purges at the Beijing Daily

The Beijing Daily, the flagship media outlet of the Beijing Municipal Party, was one of the most influential newspapers established in the early years of the People’s Republic of China. The newspaper’s principal purpose was to propagate the remarkable achievements of the Chinese Communist Party and to demonstrate the superiority of the Chinese socialist system over the capitalist one. Newly available archival sources reveal a depressing and disturbing story behind the façade of authoritative reporting: an interlocking system of control of editorial management, stringent censorship, skillful manipulation of news, and carefully selected readers’ letters in praise of the Communist regime. In the early 1960s, in contrast to the harmonious picture of Chinese society depicted by the newspaper, senior editorial staff were caught in the middle of life-and-death ideological infighting between the radical Maoists and the pragmatists in the central Party leadership. The staff used a variety of techniques – double talk, fence-sitting, paying lip service to the official lines and conducting self-criticism – to navigate through the perilous political shoals. But they were eventually purged by the Maoists during the Cultural Revolution for siding with the pragmatists. Chinese journalists, including the Beijing Daily staff who worked in the system, lived a precarious life in the authoritarian environment.

Operational efficiencies in the infusion center: Improving nursing efficiencies and patient wait times while decreasing costs.

56 Background: Decreased nursing efficiency and patient assignments has increased patient wait times and has significant implications on overall patient flow in the infusion center and labor dollars. Historically, staff nurses signed up for their patients, and took an average of 2 patients at one time. This created disparity in patient/staffing ratios, high number of labor dollars per worked infusion and an overall atmosphere of inequity among the nurses. Methods: Patient flow and labor cost were examined. Analysis of the nursing staffing matrix led to the creation of a patient placement nurse, taken from the daily staff allocation, assigning patients based on current patient assignment and acuity of patients. Nurses were identified to learn the patient placement nurse role based on critical thinking and organizational skills. With the assistance of a patient locator system, the patient placement nurse is able to identify when a patient’s wait begins and which nurse is the best choice to be assigned. A system was implemented in which a staff nurse was assigned a patient every 30-40 minutes with a maximum patient assignment of 4 concurrently. A standard 1:3 nurse to patient ratio was established unless a patient’s acuity prohibited this ratio. Results: Nursing ratios stabilized at 1:3. Staff became more efficient and work was reorganized for less subjectivity in patient assignments, producing more equitable workloads. This resulted in an increase in patients seen within 15 minutes improving from 69.8% to 85.3%. In addition, it allowed for the elimination of one nurse per day shift, resulting in a cost savings of approximately a 1.0 FTE/week or average annual salary of $62,129. Conclusions: Development of a standardized patient placement process can increase infusion center efficiencies and stabilize nursing workload, as well as decrease patient wait time and reduce the cost per infusion. This supports a delivery of patient-centered care while utilizing staff efficiently and appropriately and decreasing cost.