Unit Level Research Articles

Unit-Based Ethics Rounds: Creating an Ethical Work Culture for Nurses in the Hospital

Nurses who work in a hospital setting with seriously ill patients often face ethical dilemmas with no clear solutions but instead difficult choices and uncertainty. Unit-based ethics rounds in the hospital can be tailored to unit specific needs. However, there is a gap in the literature describing how to implement such unit-based rounds. This article describes the experience of nurses who implemented unit-based ethics rounds on one unit using the Integrated Ethics Model as a framework and the feasibility of continuing ethics education into the practice setting. Eight sessions described targeted two of the three Integrated Model’s focus areas: systems and processes, and environment and culture. Seven of the sessions targeted all three foci, and also included decisions and actions. The design of this project maximized exposure to education about ethics in nursing, reflected the unit pace and culture, and has normalized and engaged nurses in ethical thinking and actions. The Integrated Ethics Model provides a feasible framework that can focus unit-based ethics rounds and expand nursing ethics education into practice at the unit level.

A Review of Force Health Protection Aspects of Lyme Disease in the U.S. Military.

Lyme disease (LD) is an underrated threat to the military that negatively impacts mission readiness. Lyme disease has traditionally been thought to only be a risk in an operational context, where training or deployments are frequently conducted in heavily wooded environments. However, this view diminishes risks posed by many off-duty outdoor recreational activities. Furthermore, although the Army introduced a permethrin factory-treated Army Combat Uniform in 2012, permethrin retention and subsequent protection have been shown to decrease significantly after 3 months of wear. Thus, although LD is a known health risk that threatens unit readiness, beyond using treated uniforms there has been little progress at the unit level to address this threat. Focusing on a narrative review of LD and its impact on U.S. military force health protection, sources included DoD websites and policies, government press releases and information papers from sources like the CDC and FDA, and scholarly peer-reviewed journals with full-text access from the online databases EBSCOhost, MEDLINE, SCOUT, and Google Scholar. Searches included the following key words: LD and military, Army, etiology, epidemiology, incidence, treatments, post-treatment LD, and chronic LD. Articles were selected for review based on the relevance of their abstracts and titles. Although the incidence of LD appears to be increasing among service members, it is difficult to attribute this increase to military-related duties. Also, despite ongoing LD research specifically conducted and funded by the DoD, there are limited data on the mitigating effects of force education and permethrin-treated uniforms on the LD threat. Therefore, it is reasonable to conclude that LD negatively impacts military readiness and monetary costs diverted from other priorities. Lyme disease poses a genuine threat to the health and careers of service members and is an often-overlooked disruptor to military operations. Simple, feasible prevention strategies that are tailored to high-risk geographic regions can be emphasized by military units to reduce the incidence of on-duty and off-duty cases. Additionally, there remains a critical need for new preventative and diagnostic measures for LD.

Neonatologist staffing is related to the inter-hospital variation of risk-adjusted mortality of very low birth weight infants in Korea

This study investigated whether hospital factors, including patient volume, unit level, and neonatologist staffing, were associated with variations in standardized mortality ratios (SMR) adjusted for patient factors in very-low-birth-weight infants (VLBWIs). A total of 15,766 VLBWIs born in 63 hospitals between 2013 and 2020 were analyzed using data from the Korean Neonatal Network cohort. SMRs were evaluated after adjusting for patient factors. High and low SMR groups were defined as hospitals outside the 95% confidence limits on the SMR funnel plot. The mortality rate of VLBWIs was 12.7%. The average case-mix SMR was 1.1; calculated by adjusting for six significant patient factors: antenatal steroid, gestational age, birth weight, sex, 5-min Apgar score, and congenital anomalies. Hospital factors of the low SMR group (N = 10) had higher unit levels, more annual volumes of VLBWIs, more number of neonatologists, and fewer neonatal intensive care beds per neonatologist than the high SMR group (N = 13). Multi-level risk adjustment revealed that only the number of neonatologists showed a significant fixed-effect on mortality besides fixed patient risk effect and a random hospital effect. Adjusting for the number of neonatologists decreased the variance partition coefficient and random-effects variance between hospitals by 11.36%. The number of neonatologists was independently associated with center-to-center differences in VLBWI mortality in Korea after adjustment for patient risks and hospital factors.

E-waste Management Using Blockchain Technology

Introduction; Bridging the digital divide requires the provision of affordable, fair and quality ICT. With nearly two-thirds of the world’s population still offline, there is a need to provide affordable web access for everyone. For developing countries, increasing the popularity of information and communication technology has become the most important factor in reducing poverty. The danger of electrical and electronic waste disposal contains hazardous substances, but most of the electrical and electronic equipment is still disposed of in an unhealthy environment in the field development area, affecting the level of contamination in Water, Air and Soil ultimately affecting people’s health. Eliminating E-waste responsibility and protecting the environment is a challenge for countries. Smart cities can solve environmental problems through proper waste management for improving human health, protecting water resources, and reducing pollution. Objective; In this paper, we explore how blockchain technology can help smart cities to manage E-waste by providing consistency, immutability, transparency, and accountability control in a distributed, reliable, and secure manner. We discussed the advantages of blockchain technology in various aspects of E-waste management, such as instant tracking and monitoring, E-waste disposal and E-waste management regulation compliance, proper disposal management, E-waste management, and material handling, etc. All examples of disposal services, but in our study we have found that there is no fool proof system to check the disposal of E-waste whether it has been disposed off Fully or Partially. We mainly focused on the tracking of E-waste management system for 100% safe and eco-friendly disposal from the originating point of E-waste to end disposal point of total disposal. Methods; For this, we have used machine-learning model to find the existing percentage of disposal of E-waste at the end-point which reveals that it is never 100%. And partial disposal of E-waste means we have still partial E-waste around us in different forms, which will be a threat for the society to be indulged in hazardous after effects of randomly dumping E-waste.Results; After this we have modelled a Disposal Tracking System(DTS) using blockchain technology to create an E-waste data storage as Decentralized Shareable Ledger (DSL) which records the quantity and state of E-waste data from its originating point to a different level of disposal unit and finally reflect the balance of E-waste data as NIL at the end of last disposal point.Conclusion; This system will helpful for safe and ecofriendly E-waste management and it provides complete transparency and traceability of E-waste during the life cycle of complete disposal. After implementation of this system any district or Block or Village authority can ensure to its citizens for E-waste hazards free environment and safety of natural resources

Comparative Evaluation of Biofilm Formation on Temporization Crown Materials Used in the Rehabilitation of Primary Dentition With Different Polishing Materials: An In Vitro Study.

Introduction Advancements in dental materials have enhanced aesthetic treatments for managing dental caries and injuries in primary dentition. Bis-acryl composite-based temporization materials are now preferred for restoring primary crowns due to their superior properties. However, prolonged exposure to dietary and hygienic factors can lead to discoloration and roughness, making efficient polishing essential to prevent plaque buildup. Objective This study aims to evaluate Streptococcus mutans biofilm formation on temporization material polished with different polishing systems. Methods This study tested bis-acryl methacrylate temporization material. Thirty disk-shaped specimens were prepared and divided into three groups according to the polishing system used (n = 10 per group): Shofu Super Snap mini kit (Shofu, San Marcos, CA), aluminum oxide polishing paste, and propol polishing paste. Each group's specimens were polished according to the manufacturer's instructions. Surface roughness (SR), scanning electron microscopy (SEM) morphological analysis, and Streptococcus mutans biofilm formation were assessed for each group. Results The results showed significant differences in roughness average (Ra) values among the polishing materials, with the Shofu Super Snap mini kit having the highest roughness (Ra = 2.04), followed by propol polishing paste (Ra = 1.30)and aluminum oxide paste (Ra = 0.75). Additionally, polishing methods significantly affected mean colony-forming unit (CFU) levels, with the first group having the highest mean CFU value (0.24), with SEM images showing substantial biofilm formation by Streptococcus mutans. Conclusion Bacterial biofilm formation on the aluminum oxide paste group's surface differed from that on the propol polishing paste and aluminum oxide disc groups. The polishing techniques that we tested significantly influenced surface properties and biofilm formation. These findings suggest that selecting an appropriate polishing system can reduce the risk of gingival inflammation associated with temporization materials.

Penyuluhan Peningkatan Profesionalisme Guru Pendidikan Islam Anak Usia Dini (PIAUD) di TK Darul Fahmi Kecamatan Bandar Masilam Kab. Simalungun

This article was composed in view of the consequences of exploration which plans to make sense of expert educators and look for data about PAUD instructors' endeavors in creating instructor impressive skill and educational program improvement in light of the 2013 educational plan based kindergarten utilizing a subjective methodology. The conversation bunch was then dissected by decrease, order and confirmation. This examination looks to see if an expert educator can foster a kindergarten unit level educational program in light of the 2013 educational plan and assume a significant part in movements of every sort. From this exploration the creator can reason that the advancement of impressive skill of PIAUD educators can't be isolated from the mediation of bosses other than the job of the school head. With the improvement of expert PIAUD educators, the capacity of instructors to foster the 2013 Educational plan Based Kindergarten Level Educational program will likewise increment.

Predictions of Carbon Stock in the Southern Moscow Region Forests Under Different Forest Use Scenarios

The results of forest simulation modelling of the dynamics of carbon pools and fluxes in forest ecosystems under different forest management scenarios were considered on the example of the Dankovsky forest enterprise (south of the Moscow region, subzone of coniferous-broadleaved mixed forests). The impact of such changes in forest management practices, as the reserve regime, the reduction in the proportion of forest lands as a result of residential development, and zoning of the territory with an emphasis on increasing the recreational use of forests on the carbon balance was analysed. In computational experiments, a set of Russian models was used: the dynamic model of a forest stand FORRUS-S, the model of soil organic matter dynamics Romul_Hum, the model of the hydrothermal regime of soils SCLISS. Calculations were performed for a time period of 100 years at the forestry unit level, and were also aggregated at the level of the entire forestry district. The diversity of types of forest growth conditions (FGC), together with the species diversity and the initial different ages of stands, determined significant variations of the calculated indicators of forest stands’ production, the quantity and quality of plant litter entering the soil. For all cases, model estimates of changes in carbon reserves occurred in the forest stands within the initial 40–60 years with a subsequent decrease in the calculated values. Under the conservation scenario, an increase in the organic substances reserves in forest litter and soil was observed: for FGCs C2 and C3, an increase over 100 years was approximately 5–10 kg m–2, for the remaining FGCs — at the level of 2–3 kg m–2 in terms of carbon. Under the economic use scenarios, a relative “levelling” of forest enterprise area towards the lower end of the spectrum was shown in terms of soil carbon reserves. The maximum ecosystem carbon stock was calculated for FGC C2 and C3, the minimum — for A5 and C4. Depending on the scenario, over 100 years, the total net sequestration of carbon by the forests of the Dankovsky forest enterprise (with a total area of forested land of 6836 ha) was estimated within the range of 0.15–0.57 Tg.

Condition-based switching, loading, and age-based maintenance policies for standby systems

Standby techniques are widely incorporated in structural design to enhance the inherent reliability of systems. To further leverage the system performance during operation, decision-makers can adopt operational policies to manage system degradation. Specifically, at the system level, unit switching that dynamically determines the online unit contributes to avoiding unexpected shutdowns. At the unit level, adjusting load levels to manage the trade-off between condition degradation and revenue accumulation is crucial for maximizing profit. Additionally, adopting age-based maintenance as a tactical decision, which effectively facilitates the integration of maintenance resources, can be implemented to restore a degraded system. For instance, maintenance is typically scheduled at fixed moments for multi-generator power systems located in remote areas. In between maintenance moments, the proactive switching of generators can ensure uninterrupted output, and the adjustment of load levels for online generators helps to maximize output. Motivated by such engineering practices, this paper investigates condition-based switching, loading, and age-based maintenance policies for standby systems to maximize the expected profit rate in the long-run horizon. The problem is formulated as a Markov decision process. The structural properties of the control-limit switching and monotone loading policies are analyzed for easy policy implementation and efficient problem solutions. For comparative purposes, several heuristic policies are proposed and evaluated. Finally, numerical examples are presented to validate theoretical results and illustrate the superiority of the proposed risk control policy.

Mixtures of Probit Regression Models with Overlapping Clusters

Studies with binary outcomes on a heterogeneous population are quite common. Typically, the heterogeneity is modelled through varying effect coefficients within some binary regression setting combined with a clustering procedure. Most of the existing methods assign statistical units to distinct and non-overlapping clusters. However, there are scenarios where units exhibit a more complex organization and the clusters can be thought as partially overlapping. In this case, the standard approach does not work. In this paper, we define a mixture of regression models that allows overlapping clusters. This approach involves an overlap function that maps the regression coefficients, either at the unit or response level, of the parent clusters into the coefficients of the multiple allocation clusters. In order to deal with this intrinsic heterogeneity, regression analyses have to be stratified for different groups of observations or clusters. We present a computationally efficient Monte Carlo Markov Chain (MCMC) scheme for the case of a mixture of probit regressions. A simulation study shows the overall performance of the method. We conclude with two illustrative examples of modelling voting behavior, involving United States (US) Supreme Court justices over a number of topics and members of the United Kingdom (UK) parliament over divisions related to Brexit. These applications provide insights on the usefulness of the method in real applications. The method described can be extended to the case of a generic mixture of multivariate generalized linear models under overlapping clusters.

At the Junction Between Deep Learning and Statistics of Extremes: Formalizing the Landslide Hazard Definition

AbstractThe most adopted definition of landslide hazard combines spatial information about landslide location (susceptibility), threat (intensity), and frequency (return period). Only the first two elements are usually considered and estimated when working over vast areas. Even then, separate models constitute the standard, with frequency being rarely investigated. Frequency and intensity are dependent on each other because larger events occur less frequently and vice versa. However, due to the lack of multi‐temporal inventories and joint statistical models, modeling such properties via a unified hazard model has always been challenging and has yet to be attempted. Here, we develop a unified model to estimate landslide hazard at the slope unit level to address such gaps. We employed deep learning, combined with extreme‐value theory to analyze an inventory of 30 years of observed rainfall‐triggered landslides in Nepal and assess landslide hazard for multiple return periods. We also use our model to further explore landslide hazard for the same return periods under different climate change scenarios up to the end of the century. Our model performs excellently (with an accuracy of 0.78 and an area under the curve of 0.86) and can be used to model landslide hazard in a unified manner. Geomorphologically, we find that under climate change scenarios (SSP245 and SSP585), landslide hazard is likely to increase up to two times on average in the lower Himalayan regions (Siwalik and lower Himalayas; ≈110–3,500 m) while remaining the same in the middle Himalayan region (≈3,500–5,000 m) whilst decreasing slightly in the upper Himalayan region (≳5,000 m) areas.

Kepuasan Guru dalam Penggunaan E-Rapor di SMA Negeri 1 Pancung Soal Kabupaten Pesisir Selatan

E-report is a web-based software for compiling reports on student competency achievements by educational unit level developed by the SMA curriculum sub-division. By using the e-report application, it can make it easier for teachers to input the grades obtained by students. The purpose of this study is to determine the level of satisfaction of e-Rapor users with the End-User Computing Satisfaction (EUCS) model as seen from the five variables, namely content, accuracy, form, ease of use, and timeliness. This research is a quantitative descriptive research, with a population of 84 sample teachers in this study using a non-probability sampling technique, namely saturated samples so that all populations are used as samples. Using the EUCS method, this research found that teacher satisfaction with the e-report at Pancung Soal 1 Public Senior High School (SMA) Pesisir Selatan regency was satisfied with the percentage of content 80.57%, accuracy 80.95% , format 80.05%, ease of use 80.00%, timeliness 80.60%

ANALYSIS OF THE QUALITY OF PHYSICS TEXTBOOKS IN THE 2013 CURRICULUM AND THE INDEPENDENT CURRICULUM

Similar things have also been done to support the implementation of the previous curriculum, namely the School Unit Level Curriculum and the 2023 Curriculum. This study aims to compare the quality of physics textbooks recognized by the Government in the 2013 Curriculum and the Independent Curriculum. The textbooks used as samples in this study are the 11th grade physics textbooks based on the 2013 Curriculum written by Sunardi, Paramitha Retno P., and Andreas B. Dermawan in 2016 published by Yrama Widya and the physics textbooks based on the Independent Curriculum written by Marianna Magdalena Radjawane, Alvius Tinambunan and, Suntar Jono in 2022 published by the Ministry of Education, Culture, Research, and Technology. This study uses a qualitative research approach, through literature studies. Data collection was carried out by tracing various library sources related to physics teaching materials for class XI semester I. Data processing was carried out using a comparative descriptive method which includes the method of presenting material, depth of material, novelty of content and evaluation instruments. From the results of the analysis, it was found that the physics textbook for class XI of the 2013 curriculum had better quality compared to the physics textbook for class XI of the Merdeka Curriculum both in terms of indicators of material presentation, depth of material, novelty of content and evaluation instruments.

Impact of Lactobacillus- and Bifidobacterium-Based Direct-Fed Microbials on the Performance, Intestinal Morphology, and Fecal Bacterial Populations of Nursery Pigs.

Weaning is a critical stage in the swine production cycle, as young pigs need to adjust to sudden and dramatic changes in their diet and environment. Among the various organ systems affected, the gastrointestinal tract is one of the more severely impacted during this transition. Traditionally, challenges at weaning have been managed by prophylactic use of antibiotics, which not only provides protection against diarrhea and other gut dysfunction but also has growth-promoting effects. With banning or major restrictions on the use of antibiotics for this purpose, various alternative products have been developed as potential replacements, including direct-fed microbials (DFMs) such as probiotics and postbiotics. As their efficiency needs to be improved, a continued effort to gain a deeper understanding of their mechanism of action is necessary. In this context, this report presents a study on the impact of a Lactobacillus-based probiotic (LPr) and a Bifidobacterium-based postbiotic (BPo) when added to the diet during the nursery phase. For animal performance, an effect was observed in the early stages (Day 0 to Day 10), as pigs fed diets supplemented with either DFMs were found to have higher average daily feed intake (ADFI) compared to pigs fed the control diet (p < 0.05). Histological analysis of intestinal morphology on D10 revealed that the ileum of supplemented pigs had a higher villus height/crypt depth ratio (p < 0.05) compared to controls, indicating a benefit of the DFMs for gut health. In an effort to further explore potential mechanisms of action, the effects of the DFMs on gut microbial composition were investigated using fecal microbial communities as a non-invasive representative approach. At the bacterial family level, Lactobacillaceae were found in higher abundance in pigs fed either LPr (D10; p < 0.05) or BPo (D47; p < 0.05). At the Operational Taxonomic Unit (OTU) level, which can be used as a proxy to assess species composition, Ssd-00950 and Ssd-01187 were found in higher abundance in DFM-supplemented pigs on D47 (p < 0.05). Using nucleotide sequence identity, these OTUs were predicted to be putative strains of Congobacterium massiliense and Absicoccus porci, respectively. In contrast, OTU Ssd-00039, which was predicted to be a strain of Streptococcus alactolyticus, was in lower abundance in BPo-supplemented pigs on D47 (p < 0.05). Together, these results indicate that the DFMs tested in this study can impact various aspects of gut function.

Life cycle environmental impacts of urban water systems in China

Urban water systems in China are facing multiple challenges, including rapid urbanisation, climate change and infrastructure ageing. It is crucial to evaluate their environmental performance from a holistic perspective in planning and management processes. To the best of our knowledge, there is a lack of nationwide life cycle assessment (LCA) studies on China's urban water systems that cover all system stages. Therefore, this study aims to present a comprehensive and nationwide LCA analysis that pinpoints the environmental hotspots and their major sources across China. This study was conducted based on water utility databases at the province level, covering water abstraction and treatment, waterwork sludge treatment, water distribution, sewage collection, stormwater drainage, wastewater treatment and sewage sludge treatment. Nine environmental impact categories were calculated and analysed. The results reveal the inequity of environmental impacts across provinces, with overall impacts geographically higher in the east and south, lower in the west and north. However, at the functional unit level, the impacts in the northern and northeastern provinces are higher than other regions. Most environmental categories are dominated by multiple water system stages. The analyses of underlying drivers found that purchased electricity is the primary source of several environmental impacts. This study provides a holistic understanding of the environmental performance of China's urban water systems, offers some insights for comprehensive decision-making support on sustainable water system management, and can also serve as a benchmark for future scenario analysis to explore options for reducing environmental impact.

Economic Statecraft of Small States in Response to Great Power Strategic Rivalry-Take Malaysia as An Example

The foreign economic statecraft of state actors in International Relations (IRs) have often attracted much attention and discussion among scholars, but most of the existing research focuses on the economic statecraft choices of great or medium-sized powers, and there is a lack of discussion on the economic statecraft of small state actors. From the perspective of International Political Economy (IPE), this paper takes Neoclassical Realism (NCR) as the theoretical basis and adopts case studies and process tracing to analyze how Malaysia has responded to the competition of great powers such as the United States, China and Japan with different economic statecrafts. The results show that small states, like great power, possess the ability to implement different economic statecrafts, and the ability threshold, initiative, and rationality of goals are the conditions that shadow whether small countries can implement economic statecrafts. State favorability at the system level and interest preferences at the unit level jointly shape the three modes of economic statecrafts that small states use to cope with great power competition, including: offensive economic statecraft, defensive economic statecraft, and composite economic statecraft. Depending on their relative relationship and status with great powers, small states flexibly apply different economic statecrafts to realize the goals of foreign economic development and maintain national security.

Reasons influencing the nurses’ prioritization process while preventing and managing delirium: findings from a qualitative study

BackgroundNurses play an important role in the prevention and management of delirium episodes. However, some studies have reported that not all interventions recommended are applied due to time and resource constraints, resulting in patients receiving less care than required because other patients and/or interventions are prioritised. The concept of prioritization is part of the broader concept of decision-making as the ability to choose between two or more alternatives to ensure patient safety. Understanding the reasons influencing the prioritization process in patients at risk or with delirium may inform interventions to prevent and/or minimise the unfinished nursing care.AimThe purpose of this study was to explore the reasons that inform the prioritisation process among nurses when they are challenged to make decisions for patients at risk and with delirium.MethodsA descriptive qualitative study performed according to the COnsolidated criteria for Reporting guidelines, in 2021. An intentional sample of nurses working full-time with older patients in medical, geriatric, and post-acute care facilities affiliated with the National Health System was involved. Semi-structured interviews were conducted and narratives thematic analysed.ResultsA total of 56 nurses (55.4% in internal medicine, 26.8% in geriatrics and 17.8% in post-acute/intermediate care) participated with an average age of 31.6 years. The reasons informing the prioritisation process while providing preventive or managerial interventions towards a patient at risk of or with delirium are set at three levels: (1) unit level, as reasons belong to the inadequacy of the ‘Environment’, the ‘Human Resources’, and the ‘Organisation and Work Processes’, (2) nurse’s level, as issues in ‘Competencies’ and ‘Attitudes’ possessed, and (3) patient level, due to the ‘Multidimensional Frailty’.ConclusionNurses caring for patients at risk of and with delirium face several challenges in providing care. To prioritise preventive and managerial interventions, it is essential to implement multilevel and multifaced organizational and educational strategies.

Understanding and Explaining Recent Changes in Income, Consumption and Poverty Among Agricultural Households Across Major States of India

The study, using unit level data from two nationally representative surveys, examines changes in levels and sources of household income, consumption expenditure, incidence of poverty and determinants of household income and poverty among agricultural households. The study shows that across most of the states, there has been a significant decrease in the per cent share of income from cultivation coupled with an equally significant increase in the share of income from wages and salary; average annual household income of such households is higher than their average annual consumption expenditure and there has been a significant decrease in the incidence of poverty among them. The results of regression analysis show that household size, head of the household being male, literacy, farm size, income from cultivation, awareness of minimum support price (MSP), access to technical training, engagement in non-farm business and engagement in wages and salary have significant positive effect on households income and lower the probability of a household being poor across major states. JEL Codes: Q1, C1, C2, D1, R2

Analisis Penerapan Metode Activity Based Costing dalam Penentuan Harga Pokok Produksi pada UMKM Nurul Aini Mojokerto Tahun 2024

The purpose of this study was to determine and analyze the calculation of the cost of production at Nurul Aini UMKM in Mojokerto using traditional accounting and determining the cost of production based on the activity-based costing (ABC) method. This study uses a quantitative descriptive approach. Data were collected through documentation and interviews. The analysis used is quantitative descriptive analysis, which is an analysis based on decisions. The results of the study are as follows: 1. By using a traditional approach to calculate the cost of production at Nurul Aini UMKM, it was found that the raw materials used to produce motorcycle seats were 37,253,166,000, labor costs were 2,350,570,000, and factory overhead costs were 339,960,000. Thus, the cost of production of Nurul Aini UMKM in 2023 is IDR 39,943,696,000. 2) The activity-based costing system is used to calculate the COGS of Nurul Aini UMKM. To begin, the costs of activity resources must be examined. It begins by identifying and dividing activities into four levels of activity: unit level, batch-related costs, product enhancement costs, and facility enhancement costs. Next, product costs must be examined. where the cost drivers used by each product are used to limit factory overhead costs.

Predicting the effect of climate change and management on net carbon sequestration in the forest ecosystems of the European part of Russia with the complex of models

The objectives of sustainable development require the ability to estimate potential changes in net carbon sequestration in forest ecosystems (including changes in biomass, mortmass, and soil organic matter) under possible climate change and different forest management strategies. Such estimates require consideration of different ecosystem components and processes. To achieve this goal, we have integrated several ecological models (dynamic stand model FORRUS-S, soil organic matter model Romul_Hum, statistical climate generator SCLISS and process-based forest ecosystem model EFIMOD3) to simulate the ecosystem dynamics at the regional level in several study areas within the forest zone of the European part of Russia. The simulation results reflected both the direct effects of climate change and forest management actions on ecosystem carbon pools, and the indirect effects through changes in species composition. The simulation experiments were spatially detailed at the level of individual forest management units, thereby revealing the influence of habitat conditions on the rate of carbon sequestration under the influence of environmental factors. We found that net carbon sequestration in all major ecosystem pools was mostly positive, ranging between 0 and 1.45 t ha year−1 depending on study area and simulation scenario. Higher accumulation was typically observed in medium-rich and rich habitat types with mesic moistening. In the long term, the effect of climate change was found to be comparable to the effect of management interventions.

COVID-19 Pandemic Increases in Nursing-Sensitive Quality Indicators.

The pandemic profoundly stressed practicing nurses and could have thereby affected trends in nursing-sensitive quality indicators (NSIs), measures that detect changes in patient health status directly affected by nursing care. The aim of the study was to determine if NSIs have worsened in response to the pandemic and then returned to prepandemic levels using data from 2019 through 2022. We conducted a cross-sectional descriptive study of annual trends, examining unit data from the National Database of Nursing Quality Indicators (NDNQI) from 2019 through 2022 for five indicators: rates of falls, central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), hospital-acquired pressure injuries (HAPI), and ventilator-associated events (VAE). The NDNQI is the largest repository of nursing quality indicators, which are derived from patient-level events, reported at the nursing unit level, and submitted quarterly by over 2,000 member hospitals. Adult medical-surgical or critical care inpatient nursing units with complete data for the 4 years were included, with samples ranging from 456 to 5,818 nursing units in 2,346 hospitals. Analysis of variance was conducted by comparing the 2019 rates to each subsequent year. In decreasing order of prevalence, the mean prepandemic rates were 6.58 VAE per 1,000 ventilator days (critical care only), 2.41 HAPI per 1,000 device days, 2.20 falls per 1,000 patient days, 0.96 CAUTI per 1,000 catheter days, and 0.68 CLABSI per 1,000 central line days for medical-surgical and critical care units combined. The rates for all five nurse-sensitive indicators increased significantly beginning in 2020 and have begun to decline but have not returned to baseline by 2022. The maximum rate was observed in 2020 for falls and 2021 for the remaining indicators. These increases to the maximum ranged from a 12% increase in CAUTI to 49% for CLABSI. NSIs increased during the pandemic and are now returning to baseline. The pandemic underscored the importance of nursing practice. The pandemic's enduring negative effects on the nursing workforce must be addressed to preserve patient safety.