Tertiary Organization Research Articles

E-learning and Higher Education

Originally published in 2012, over an 18-month period four New Zealand educational institutions—a university, a private tertiary enterprise, a wānanga, and an institute of technology/polytechnic— have engaged in a process of change influenced by technology. Their e-learning capability was benchmarked using the E-Learning Maturity Model, and this information was used to stimulate change activities. The resulting case studies, discussed in this paper, illustrate the issues that face tertiary organisations and leaders engaging with the opportunities and challenges of e-learning. Five factors have been identified as significant influences on the ability of organisations to change in response to technology in the current political and educational landscape of the New Zealand tertiary sector.

Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment

IntroductionOver the past two decades, Tanzania’s burden of non-communicable diseases has grown disproportionately, but limited resources are still prioritized. A trained human resource for health is urgently needed to combat these diseases. However, continuous medical education for NCDs is scarce. This paper reports on the mid-level healthcare workers knowledge on NCDs. We assessed the knowledge to measure the effectiveness of the training conducted during the initiation of a Package for Essential Management of Severe NCDs (PEN Plus) in rural district hospitals in Tanzania.MethodsThe training was given to 48 healthcare employees from Dodoma Region’s Kondoa Town Council District Hospital. For a total of five (5) days, a fundamental course on NCDs featured in-depth interactive lectures and practical workshops. Physicians from Tanzania’s higher education institutions, tertiary university hospitals, research institutes, and medical organizations served as trainers. Before and after the training, a knowledge assessment comprising 28 questions was administered. Descriptive data analysis to describe the characteristics of the specific knowledge on physiology, diagnosis and therapy of diabetes mellitus, rheumatic fever, heart disease, and sickle cell disease was done using Stata version 17 (STATA Corp Inc., TX, USA).ResultsComplete assessment data for 42 out of the 48 participants was available. Six participants did not complete the training and the assessment. The mean age of participants was 36.9 years, and slightly above half (52%) were above 35 years. Two-thirds (61.9%) were female, and about half (45%) were nurses. The majority had the experience of working for more than 5 years, and the average was 9.4 years (+/- 8.4 years). Overall, the trainees’ average scores improved after the training (12.79 vs. 16.05, p < 0.0001) out of 28 possible scores. Specifically, trainees’ average scores were better in treatment than in diagnosis, except for sickle cell disease (1.26 vs. 1.83). Most were not able to diagnose rheumatic heart disease (47.6% able) compared to diabetes mellitus (54.8% able) or sickle cell disease (64.3% able) at baseline. The proportion of trainees with adequate knowledge of the treatment of sickle cell disease and diabetes mellitus was 35% and 38.1%, respectively, and there was a non-statistical difference after training. Those working for less than 5 years had a higher proportion of adequate knowledge (30.8%) compared to their more experienced colleagues (6.9%). After the training, participants’ knowledge of NCDs increased by three times (i.e., aPR 3, 95% CI = 1.1, 1.5, and 6.0).Conclusion and recommendationsPEN Plus training improved the knowledge of healthcare workers at Kondoa Town Council District Hospital. Training is especially needed among nurses and those with a longer duration of work. Continuing education for human resources for health on the management of NCDs is highly recommended in this setting.

RNAscape: geometric mapping and customizable visualization of RNA structure.

Analyzing and visualizing the tertiary structure and complex interactions of RNA is essential for being able to mechanistically decipher their molecular functions in vivo. Secondary structure visualization software can portray many aspects of RNA; however, these layouts are often unable to preserve topological correspondence since they do not consider tertiary interactions between different regions of an RNA molecule. Likewise, quaternary interactions between two or more interacting RNA molecules are not considered in secondary structure visualization tools. The RNAscape webserver produces visualizations that can preserve topological correspondence while remaining both visually intuitive and structurally insightful. RNAscape achieves this by designing a mathematical structural mapping algorithm which prioritizes the helical segments, reflecting their tertiary organization. Non-helical segments are mapped in a way that minimizes structural clutter. RNAscape runs a plotting script that is designed to generate publication-quality images. RNAscape natively supports non-standard nucleotides, multiple base-pairing annotation stylesand requires no programming experience. RNAscape can also be used to analyze RNA/DNA hybrid structures and DNA topologies, including G-quadruplexes. Users can upload their own three-dimensional structures or enter a Protein Data Bank (PDB) ID of an existing structure. The RNAscape webserver allows users to customize visualizations through various settings as desired. URL: https://rnascape.usc.edu/.

Nursing Students’ Perceptions of Assisted Dying: A Qualitative Study

Assisted dying became a legal choice in November 2021 following the passing of the End of Life Choice Act (2019) in New Zealand. This new means of dying allows individuals to pursue the right to die should they meet the legislated criteria. The availability of assisted dying raises questions regarding nursing practices and responsibilities in relation to the service. The aim of this study was to gain insight into nursing students’ views about assisted dying in Aotearoa New Zealand. A qualitative descriptive study using a qualitative survey with a paper-based questionnaire was undertaken among nursing students enrolled in a Bachelor of Nursing (BN) programme at a single tertiary education organisation in 2019. Responses from 192 students were analysed using content analysis. Three categories were identified: supportive on the basis of personal choice; disapproval on the basis of personal beliefs; and taking a professional stand as a nurse. The categories present the distinct and opposing views expressed by nursing students regarding assisted dying, with the extent of support or disapproval being supported by their recognition of personal autonomy, their own belief systems and their views of roles expected of nurses. This research highlighted that nursing students’ views about assisted dying were influenced by both personal and professional factors, and at times these were dichotomous. Ethical and practice challenges concerning assisted dying must be recognised and acknowledged. The nursing education sector should include topics related to assisted dying in the curricula and work with students to, where necessary, reconcile any ethical issues that arise. This will ensure that future nurses are prepared and equipped with knowledge and skills in providing care to patients and families considering or requesting assisted dying. Te reo Māori translation Ngā whakaaro o ngā pia tapuhi ki te mate whakaahuru: He rangahau kounga Ngā Ariā Matua I whakamanaia ā-turetia te mate whakaahuru o te tangata i te marama o Nōema 2021 i muri i te pāhitanga o te Ture mō te Whiringa mō te Mutunga o te Oranga (2019) i Aotearoa. Mā tēnei ara hou ki te matenga ka taea e te tangata takitahi te whai i tana tika kia mate, ki te tutuki i a ia ngā paearu ā-ture. Nā te wāteatanga mai o te mate whakaahuru mō te tangata, ka ara ake ētahi pātai mō ngā tikanga mahi tapuhi me ō rātou haepapa mō te kaupapa āwhina hou. Te whāinga o tēnei rangahau he whai kia mārama ki ngā whakaaro o ngā pia tapuhi ki te mate whakaahuru o te tangata i Aotearoa. I mahia tētahi rangahau whakaahua kounga nā te whakamahi uiuinga kounga, ki tētahi rārangi pātai pepa i waenga i ngā pia tapuhi i rēhitatia ki tētahi akoranga Paetahi mō Te Tapuhitanga (BN) i tētahi whare whakaako kotahi i 2019. I tātaritia ngā whakautu mai i ngā ākonga 192 nā te whakamahi tātaritanga kōrero. E toru ngā kāwai i tautuhitia: ērā i tautoko i runga i te whiringa whaiaro; te korenga e whakaae i runga i ngā whakapono tāngata takitahi; me te tū hei tangata ngaio, arā, hei tapuhi. Ko ngā kāwai kei te whakaari i ngā tū motuhake, tauaro hoki i whakapuakina e ngā pia tapuhi mō te mate whakaahuru, me kī, kei te āhua o tō rātou whakaae ki te mana motuhake o te tangata mōna anō, o ō rātou pūnaha whakapono, me tō rātou titiro ki ngā mahi e tika ana mā te tapuhi, te kaha tautoko, te kaha whakahē rānei ki te ara hou. Tā tēnei rangahau he whakatairanga i te kawenga o ngā whakaaro o ngā pia tapuhi mō te mate whakaahuru e ngā pūtake whaiaro, me ngā pūtake ngaio, ā, i ētahi wā he noho tauwehe ēnei pūtake e rua. Me mātua kite, me mātua urupare ki ngā wero matatika me ngā wero i te wāhi mahi o te mate whakaahuru. Me uru ki te rāngai akoranga tapuhi ētahi kaupapa e pā ana ki te mate whakaahuru i roto i te marautanga me te mahi tahi ki ngā ākonga ki te tuitui tahi i ngā take matatika ka ara ake, i ngā wāhi e tika ana. Mā konei ka tika te whakangungu, te hoatu pūkenga hoki ki ngā tapuhi o āpōpō, ka whiwhi hoki i te mātauranga me ngā pūkenga e tika ana hei tiaki i ngā tūroro me ō rātou whānau e whiriwhiri nei, e inoi nei rānei, ki te mate whakaahuru mō rātou. Ngā kupu matua mate whakaahuru; te taurimatanga i te mutunga o te ora; ngā ture; te akoranga tapuhi; ngā pia tapuhi; te rangahau kounga

In-cell investigation of the conformational landscape of the GTPase UreG by SDSL-EPR

UreG is a cytosolic GTPase involved in the maturation network of urease, an Ni-containing bacterial enzyme. Previous investigations invitro showed that UreG features a flexible tertiary organization, making this protein the first enzyme discovered to be intrinsically disordered. To determine whether this heterogeneous behavior is maintained in the protein natural environment, UreG structural dynamics was investigated directly in intact bacteria by in-cell EPR. This approach, based on site-directed spin labeling coupled to electron paramagnetic resonance (SDSL-EPR) spectroscopy, enables the study of proteins in their native environment. The results show that UreG maintains heterogeneous structural landscape in-cell, existing in a conformational ensemble of two major conformers, showing either random coil-like or compact properties. These data support the physiological relevance of the intrinsically disordered nature of UreG and indicates a role of protein flexibility for this specific enzyme, possibly related to the regulation of promiscuous protein interactions for metal ion delivery.

Effect of Emotional Intelligence on Employee Caring Behaviour: a Study of Professional Nurses in Tertiary Health Care Institutions in Benue State, Nigeria

This study examined the effect of emotional intelligence on caring behaviour of professional nurses in tertiary health care institutions in Benue State, Nigeria. Specifically the study sought to examine the effects of self-awareness, self-management, social awareness and relationship management on caring behaviour of professional nurses in tertiary health care institutions in Benue State. Anchored on Jean Watson’s Theory of Human Caring, the study adopted the survey design. Population of the study consisted of 586 professional nurses working in the two tertiary healthcare facilities in Benue State (312 from the Federal Medical Centre and 274 from the Benue State University Teaching Hospital). A sample size of 245 was arrived at with the aid of Taro Yamene’s sampling formula. Primary data were gathered through questionnaire. The data were coded and analysed with the aid of SPSS. Hypotheses of the study were tested using regression analysis at 5% level of significance. Findings revealed that self-awareness, self-management, social awareness and relationship management all have significant effect on caring behaviour of professional nurses in tertiary health care institutions in Benue State, Nigeria. The study concludes that there is a significant relationship between emotional intelligence and caring behaviour of professional nurses in tertiary health care institution in Benue State. The study recommends that in order to ensure quality care to patients, management of tertiary healthcare organisations in Benue State should recognize and develop EI abilities in nurses who constantly struggle to show care since EI can be taught and learnt.

Paediatric family activation rapid response (FARR) in tertiary healthcare organisations: Protocol for an online, multi-lingual, application (app) intervention development study

IntroductionAt least 85% of unplanned admissions to critical care wards for children and young people (CYP) are associated with clinical deterioration. CYP and their families play an integral role in the recognition of deterioration. The Paediatric Critical Care Outreach Team (PCCOT) supports the reduction of avoidable harm through earlier recognition and treatment of the deteriorating child, acting as a welcome conduit between the multiprofessional teams, helping ensure that CYP gets the right care, at the right time and in the right place. This positions PCCOT well to respond to families who call for help as part of family activation.AimThis protocol details the methods and process of developing a family activation rapid response online application.MethodsThis is a single-centre, sequential, multiple methods study design. Firstly, a systematic review of the international literature on rapid response interventions in paediatric family activation was conducted. Findings from the review aimed to inform the content for next stages; interviews/ focus groups and experience-based co-design (EBCD) workshops. Participants: parents / caregivers whose children have been discharged or admitted to an acute care hospital and healthcare professionals who care for paediatric patients (CYP). During interviews and workshops participants’ opinion, views and input will be sort on designing a family activation rapid response online-app, detailing content, aesthetics, broad functionality and multi-lingual aspects. Further areas of discussions include; who will use the app, access, appropriate language and terminology for use.A suitable app development company will be identified and will be part of the stakeholders present at workshops. Data obtained will be used to develop a multi-lingual paediatric family activation rapid response web based application prototype.Ethics and disseminationFull ethical approval was received from the Wales Research Ethics Committee 2.Cardiff; REC reference: 22/WA/0174. The findings will be made available to all stakeholders.

Multiple non-canonical base-stacking interactions as one of the major determinants of RNA tertiary structure organization

Interplane (stacking) interactions of heterocyclic bases of nucleotide residues (n.t.) of RNA are one of the most important factors in the organization of its secondary and tertiary structure. Most of these (canonical) interactions are carried out between neighbors in the polynucleotide chains of RNA. However, with the accumulation of data on the atomic tertiary structures of a wide variety of RNAs and their complexes with proteins, it became clear that RNA nucleotide residues that are not neighbors in their polynucleotide chains and are sometimes separated in the RNA primary structure by tens or hundreds of n.t. can interact with the help of base stacking (non-canonical). This paper presents an exhaustive database of such elements and their environment in the macromolecules of natural and synthetic RNAs. They were called nonadjacent base-stacking elements (NA-BSE). The analysis of these data showed that the NA-BSE forming nucleotides, on average, account for about a quarter of all nucleotides of a particular RNA, therefore, they should be considered as real motifs in their tertiary structure. The classification of NA-BSE by types of localization in RNA macromolecules is carried out. It is shown that the structure-forming role of NA-BSE consists in the compact folding of single-stranded RNA loops, in the transformation of double-stranded bulges into imperfect helices, as well as in the binding of RNA regions removed in their primary and secondary structure.

Congruence, personality and centrality in small organization social networks

Objective: To analyze the associations between congruence, personality and centrality in two intra-organizational networks: search for support and selection of professional teams. Originality: Investigate how person-environment adaptation works in work groups using social networks. Method: 61 professionals linked to a tertiary sector organization participated. The Vocational Interest Scale (VIS) and the Occupational Classification Inventory Revised (OCI-R) were used to estimate congruence, and the Next Big Five Inventory (BFI-2) was used to measure personality, as well as centrality measures using the Social Networks Analysis. Results: Congruence was positively associated with Out Closeness Centrality (OCC) for the two investigated networks. Only in the support network were found negative associations between Agreeableness and Out Closeness Centrality (OCC) and also between Neuroticism and In Degree Centrality (IDC) and In Closeness Centrality (ICC). Limitations and implications are at the end of the study.

NGOS and stakeholder cooperation in long term care organizing and delivery: an equal player or an outlier?

This paper summarizes the arguments and counterarguments within the scientific discussion on the issue of inter-sectoral and inter-organizational cooperation in long-term care service policy-making, organizing and delivery with a specific focus on NGO role in it. The main purpose of the research is to explore the current situation, with a specific focus on NGO role in it, and look into some drivers of stakeholder cooperation in LTC organising and delivery and to compare them across public and private LTC providers and NGOs. Systematization of the literary sources and approaches indicates that NGOs’ role in stakeholder cooperation is unique due to the nature of their non-profit philosophy. The relevance of this scientific problem decision is that inter-organisational LTC cooperation with and by tertiary sector organisations has to date received very modest research attention, and is inconclusive and fragmented. This leads to not meeting growing needs for LTC services and increasing public costs. Investigation of the topic first offers empirical evidence on stakeholder cooperation in LTC policy development, organising and delivery across multiple stakeholder groups in three sectors – public, private and NGOs. In addition, it pays specific attention to NGOs role and engagement in LTC and identifies stronger and weaker areas of cooperation with other stakeholders. The paper also identifies several cooperation drivers and measures them in LTC field. The study builds on the findings of a survey of key LTC stakeholders in Lithuania (n=215). Results show that current NGO engagement in cooperation is lower in comparison to public and private LTC service providers and their cooperation is mainly limited to the sphere of LTC service delivery at an individual level, and family members, social workers and other NGOs make key stakeholder groups they cooperate with. The research empirically confirms that NGOs are outliers in cooperation in long-term care policy development, organising and delivery across multiple stakeholder groups. The results of the research can be useful for all the stakeholders in LTC policy field and service provision.

A Machine Learning Model for Predicting the Risk of Readmission in Community-Acquired Pneumonia.

Background Pneumonia is a common respiratory infection that affects all ages, with a higher rate anticipated as age increases. It is a disease that impacts patient health and the economy of the healthcare institution. Therefore, machine learning methods have been used to guide clinical judgment in disease conditions and can recognize patterns based on patient data. This study aims to develop a prediction model for the readmission risk within 30 days of patient discharge after the management of community-acquired pneumonia (CAP). Methodology Univariate and multivariate logistic regression were used to identify the statistically significant factors that are associated with the readmission of patients with CAP. Multiple machine learning models were used to predict the readmission of CAP patients within 30 days by conducting a retrospective observational study on patient data. The dataset was obtained from the Hospital Information System of a tertiary healthcare organization across Saudi Arabia. The study included all patients diagnosed with CAP from 2016 until the end of 2018. Results The collected data included 8,690 admission records related to CAP for 5,776 patients (2,965 males, 2,811 females). The results of the analysis showed that patient age, heart rate, respiratory rate, medication count, and the number of comorbidities were significantly associated with the odds of being readmitted. All other variables showed no significant effect. We ran four algorithms to create the model on our data. The decision tree gave high accuracy of 83%, while support vector machine (SVM), random forest (RF), and logistic regression provided better accuracy of 90%. However, because the dataset was unbalanced, the precision and recall for readmission were zero for all models except the decision tree with 16% and 18%, respectively. By applying the Synthetic Minority Oversampling TEchnique technique to balance the training dataset, the results did not change significantly; the highest precision achieved was 16% in the SVM model. RF achieved the highest recall with 45%, but without any advantage to this model because the accuracy was reduced to 65%. Conclusions Pneumonia is an infectious disease with major health and economic complications. We identified that less than 10% of patients were readmitted for CAP after discharge; in addition, we identified significant predictors. However, our study did not have enough data to develop a proper machine learning prediction model for the risk of readmission.

BLOODSTREAM INFECTIONS IN COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

Many COVID-19 studies are about epidemiological and clinical features but information about secondary bacterial infections is limited. The presentstudy was conducted to determine the prevalence andcharacteristics of bloodstream infections in COVID-19 patients admitted to a tertiary care academic healthcare organization. All blood samples were obtained from patients with COVID-19 admitted were includedin the study. Blood cultures were performed using BD BACTEC ™ FX40, and the diagnosis and bacterialidentification and antimicrobial sensitivity was performed by manual method. 2200 patients with COVID-19 were hospitalized during a 6-month study period in which 315 blood cultures were performed. Of these,24 (7.61%) were positive. The median age of patients with positive blood culture was 38 years and included13 males and 11 females. Seventeen patients (70.83%) needed intensive care in the ICU. Significantcorrelations with blood culture positivity have been noted with parameters such as admission to the ICU,availability of accommodation, basic illness and adverse clinical outcomes. Bloodstream infectionsprevalence in COVID-19 patients is low. However, antibiotic prophylaxis needs to be used with caution, andimmediate discontinuation should be made based on clinical judgment.

Tertiary and Quaternary Structure Organization in GMP Synthetases: Implications for Catalysis

Glutamine amidotransferases, enzymes that transfer nitrogen from Gln to various cellular metabolites, are modular, with the amidotransferase (GATase) domain hydrolyzing Gln, generating ammonia and the acceptor domain catalyzing the addition of nitrogen onto its cognate substrate. GMP synthetase (GMPS), an enzyme in the de novo purine nucleotide biosynthetic pathway, is a glutamine amidotransferase that catalyzes the synthesis of GMP from XMP. The reaction involves activation of XMP though adenylation by ATP in the ATP pyrophosphatase (ATPPase) active site, followed by channeling and attack of NH3 generated in the GATase pocket. This complex chemistry entails co-ordination of activity across the active sites, allosteric activation of the GATase domain to modulate Gln hydrolysis and channeling of ammonia from the GATase to the acceptor active site. Functional GMPS dimers associate through the dimerization domain. The crystal structure of the Gln-bound complex of Plasmodium falciparum GMPS (PfGMPS) for the first time revealed large-scale domain rotation to be associated with catalysis and leading to the juxtaposition of two otherwise spatially distal cysteinyl (C113/C337) residues. In this manuscript, we report on an unusual structural variation in the crystal structure of the C89A/C113A PfGMPS double mutant, wherein a larger degree of domain rotation has led to the dissociation of the dimeric structure. Furthermore, we report a hitherto overlooked signature motif tightly related to catalysis.

Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys

BackgroundThe impacts of electronic medical record implementation on nurses, the largest healthcare workforce, have not been comprehensively examined. Negative impacts on nurses have implications for quality of patient care delivery and workforce retention. ObjectiveTo investigate changes in nurses’ well-being, intention to stay, burnout, work engagement, satisfaction, motivation and experience using technology pre- and post-implementation of an organisation-wide electronic medical record in Victoria, Australia. MethodsThe natural experiment comprised an electronic medical record system implementation across six hospitals of a large tertiary healthcare organisation. Cross-sectional surveys were collected pre-electronic medical record implementation prior to the SARS-CoV-2 pandemic in 2019, and 18-months post-electronic medical record implementation during the pandemic in 2020, and findings compared. ResultsA total of 942 surveys were analysed (550 pre-electronic medical record (response rate 15.52%) and 392 post-electronic medical record (response rate 9.50%)). Post-electronic medical record, nurses’ work satisfaction (r = 0.23, p=<0.001), intention to stay (r = 0.11, p = 0.001) and well-being (r = 0.17, p=<0.001) decreased. Nurses’ perceived competence increased (r = 0.10, p = 0.002) despite decreased autonomy (r = 0.10, p = 0.003). Two of three dimensions of work engagement worsened (vigour r = 0.13, p=<0.001; dedication r = 0.13, p=<0.001) and all dimensions of burnout increased (exhaustion r = 0.08, p = 0.012, cynicism r = 0.07, p = 0.04 and reduced efficiency r = 0.32, p=<0.001). Nurses reported more burnout symptoms (95% CI 4.6–4.7%, p = 0.036), were less engaged (95% CI 49.6–49.9%, p=<0.001) and career trajectory satisfaction decreased (r = 0.15, p=<0.001). Matched data from 52 nurses showed changes in the same direction for all items except career trajectory satisfaction, hence validated findings from the larger unmatched sample. ConclusionsImplementation of an electronic medical record immediately followed by the SARS-CoV-2 pandemic was associated with negative changes in nurses’ well-being, intention to stay, burnout, work engagement and satisfaction.

Success factors for lean six sigma projects in healthcare

Identifying critical success factors (CSFs) of continuous improvement projects is crucial for management control and operations management domains. Despite the availability of manufacturing-related literature, studies on CSFs in more dynamic and complex healthcare-related operations are scarce. This study, based at a large public tertiary healthcare organization, identifies CSFs in implementing Lean Six Sigma (LSS). 62 LSS projects completed by Green Belts in consultation with Black Belts were analyzed for project success by a review team of practitioners (Black Belters) and academics. Using a grounded theory approach, numerous success factors were initially identified. A series of brainstorming sessions and workshops helped to narrow down and revise all the CSFs present in each of the 62 LSS projects to eight CSFs. The success of the 62 completed projects was assessed against each of the eight CSFs on a five-point Likert scale. Success was measured against whether the project met its stated aim and achieved the Key Performance Indicators that had initially been identified. Finally, the correlations of each factor rating against project success were analyzed to validate the relationship between each success factor and project success. The findings confirm that all eight CSFs identified are significantly correlated to project success. This study contributes to the management control, operations management, and healthcare literature by identifying CSFs of continuous improvement projects and introducing a relatively unique, rigorous, and practically proven evaluation method applied via an industry and academic partnership. Specified CSFs and the method used to identify these will benefit managers of continuous improvement projects.

Nurse unit managers’ work and impacts on clinical leadership: A cross-sectional study

<h2>ABSTRACT</h2><h3>Problem/Background</h3> Nurse unit managers are critical to clinical leadership and play an important role in the contemporary context of health care management. Lack of role satisfaction and reports of excessive workloads place this crucial role at risk; it is therefore essential to understand the workplace factors that influence the important work of nurse unit managers, and the stressors that impact their leadership practices. <h3>Aim</h3> To capture and explore nurse unit managers' perceptions of their work and leadership practices within a large, multi-facility tertiary healthcare organisation. <h3>Methods</h3> A cross-sectional study with a convenience sample of nurse unit managers (n=34) in an Australian health service was undertaken. A multi-dimensional instrument included socio-demographics, validated scales (perceived organisational support, work engagement, intentions to stay), purposefully developed scales (administrative workload, clinical leadership profile), and an open-ended question (clinical leadership aspirations). Nurse unit managers' demographics and scales were analysed descriptively; content analysis was used to code the qualitative data. <h3>Findings</h3> Nurse unit managers were clinically experienced, had limited postgraduate education, worked excessive hours, had high administrative loads, and enacted multiple leadership categories. Work engagement was characterised by absorption and dedication, nurse unit managers were ambivalent in their perceptions of organisational support. Nurse unit managers expressed aspirations for clinical leadership and wished to retain their positions in the organisation. <h3>Discussion</h3> Due to the critical role of nurse unit managers within health systems, it is vital that knowledge of nurse unit managers' work and leadership practices are investigated. Nurse unit managers' clinical leadership activities and aspirations require ongoing clarification. Relationships between perceived organisational support, work engagement, and nurse unit managers' intentions to stay need further exploration. The level of post-registration qualification in the workforce needs to be raised. <h3>Conclusion</h3> Increased awareness of leadership realities and workplace factors that influence nurse unit managers could be used for advancing clinical leadership and ongoing role development.

The Concept of Sense in Gilles Deleuze'sLogic of Sense

What is the concept of sense developed by Deleuze in his 1969 Logic of Sense? This paper attempts to answer this question analysing the three dimensions of language that Deleuze isolates: the primary order of noises and intensities (depth); the secondary order of sense (surface); and the tertiary organisation of propositions (height). What renders language possible is that which separates sounds from bodies (the primary order) and organises them into propositions (the tertiary organisation), freeing them for the expressive function. Deleuze argues that it is the dimension of sense that brings about this genesis of language, and he analyses in detail the three syntheses (connection, conjunction and disjunction) that bring about the production of this surface of sense. Yet Deleuze also distinguishes between two types of non-sense: the nonsense of Lewis Carroll's portmanteau words, which remain ensconced in the dimension of sense, and the more profound nonsense of Antonin Artaud's psychotic scream-breaths (‘Ratara ratara ratara Atara tatara rana Otara otara katara’), which penetrate the almost unbearable world of the primary order of noise and intensities. In the end, the focus of Logic of Sense is less the surface domain of sense than the primary depth of corporeal intensities. What Deleuze calls a ‘minor’ use of language is nothing other than an intensive use of language that constitutes a principle of metamorphosis.

Statistical and machine learning analysis of non-clinical factors impacting emergency room delays

IntroductionPlenty is known about the clinical factors impacting the time patients spend in emergency departments (EDs), but less is known about associated non-clinical factors. Here we fill this knowledge gap through a statistical and machine learning (ML) analysis of the non-clinical factors impacting ED length of stay (LoS). MethodsData from adult patients visiting the tertiary healthcare organization ED, Riyadh between January 2017 and October 2019 were subjected to logistic regression and multiple ML classification models to predict non-clinical factors associated with delayed ED LoS (>6 h). ResultsThere were 352,230 emergency visits by 135,185 patients. Most were under 6 h, with only 18% exceeding that benchmark. In logistic regression analysis, weekend visits, in the summer, by elderly male patients were associated with delayed ED LoS. The results of this study and the analysis of non-clinical factors in general can be used to aid in administrative decisions in EDs, such as deciding the number of staff per shift or provide the patients with the expected LoS to help them make decisions whether to stay or leave. ConclusionLogistic regression revealed some associations between ER LoS and the included factors. However, ML models showed disappointing performance with the included non-clinical predictive variables. Further research to examine the impact of both clinical and non-clinical parameters on ED delay is now needed.

Impact of body mass index on critically ill COVID-19 patients admitted in a tertiary care hospital : a retrospective observational study

Background: Increased body mass index (BMI) is a known risk factor for respiratory infection and is being recognized as a predisposing factor in the COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus‐2. Aims and Objectives: This study aimed to assess the association between different body mass index categories with severe COVID-19 patients leading to death. Materials and Methods: This retrospective study of six months included the laboratory-confirmed COVID-19 patients admitted to an ICU of a tertiary care academic health care organization. The medical records were reviewed at least 14 days after admission. Results: 484 patients were included, and BMI data were available for 306 patients. 40.19% had a normal weight, 26.79% were overweight, 17.97% had BMI 30-34.9 Kg/m2 and 15.03% had BMI ≥ 35 Kg/m2. Overall, 58 patients (18.95%) died within 14 days of ICU admission, 50.98% were discharged alive or referred from the hospital within 14 days, and 30.06% remained hospitalized at 14 days. After controlling for all covariates, there was a significantly increased risk of mortality in the patients with obesity class I (RR 2.03, 95% CI 1.07-3.85, P = 0.030) and patients with obesity class II &amp; III (RR 2.83, 95% CI 1.54–5.22, P &lt;0.001) compared with those with normal BMI. Conclusions: Obesity was associated with an unfavorable outcome among patients with COVID-19. Patients with obesity should be more closely monitored when hospitalized for COVID-19 as there is increasing evidence of relation of severity of COVID-19 and obesity which appears to be a factor in the health risks.

Indigenous peoples in Russian Arctic labour market

Abstract The article is dealing with indigenous peoples’ sustainability issues in Russian Arctic labour market. There we surveyed 74 indigenous communities and 32 municipal unitary enterprises in the Arctic. Obtained data helped to identify demanded occupations for indigenous peoples in the Russian Arctic for the period of 2035. It turned out that 75% of respondents continue working in occupations that are traditional for indigenous peoples (reindeer farmer, coastal fisherman, whale hunter etc.) in the Russian Arctic, 25% continue working in occupations demanded in Arctic labour market mainly in social sphere (doctor, teacher and kindergarten teacher). Both Rosstat data and indigenous peoples’ surveys’ results indicated that indigenous peoples are usually not enrolled in vocational educations programmes. After graduating both schools and boarding schools, indigenous peoples usually do not continue their education. They also have a high disposal rate at tertiary vocational education organisations in case they are enrolled. Unequal access to education as well as labour market is a strong characteristic of indigenous peoples in the Russian Arctic.