Articles de revues sur le sujet « Retention-related dispositions »

The aim of this study was to better understand socio-demographic differences of individuals in terms of their psychological career meta-capacities (measured by the Psychological Career Resources Inventory) and their retention related dispositions construct variables ((measured by the Utrecht Work Engagement Scale and Organisation-Related Commitment Scale). A quantitative survey was conducted involving a non-probability purposive sample of predominantly black females employed at managerial and staff levels (N = 318) in the field of industrial and organisational psychology. An independent-samples t-test indicated significant differences between the various socio-demographic groups in regard to the measured variables. The findings contribute new knowledge that may be used to inform human resource career development practices concerned with the retention of particularly female employees in South African service industry.

Evolutionary theory and empirical studies suggest that many animals, including humans, have a genetic predisposition to acquire and retain property. This is hardly surprising because survival is closely bound up with the acquisition of things: food, shelter, tools and territory. But the root of these general urges may also run to quite specific and detailed rules about property acquisition, retention and disposition. The great variation in property-related behaviours across species may mask some important commonalities grounded in adaptive utility. Experiments and observations in the field and laboratory suggest that the legal rules of temporal priority and possession are grounded in what were evolutionarily stable strategies in the ancestral environment. Moreover, the preferences that humans exhibit in disposing of their property on their deaths, both by dispositions made in wills and by the laws of intestacy, tend to advance reproductive success as a result of inclusive fitness pay-offs.

A major research thrust in science, technology, engineering, and mathematics (STEM) education is focused on how to retain students as STEM majors. The accumulation of seemingly insignificant negative experiences in STEM classes can, over time, lead STEM students to have a low sense of belonging in their disciplines, and this can lead to lower retention. In this paper, we explore how Judeo-Christian students in biology have experiences related to their religious identities that could impact their retention in biology. In 28 interviews with Judeo-Christian students taking undergraduate biology classes, students reported a religious identity that can conflict with the secular culture and content of biology. Some students felt that, because they are religious, they fall within a minority in their classes and would not be seen as credible within the biology community. Students reported adverse experiences when instructors had negative dispositions toward religion and when instructors were rigid in their instructional practices when teaching evolution. These data suggest that this may be a population susceptible to experiences of cultural conflict between their religious identities and their STEM identities, which could have implications for retention. We argue that more research should explore how Judeo-Christian students’ experiences in biology classes influence their sense of belonging and retention.

The extant literature on goal orientation is primarily focused on scholastic and athletic achievement. This study extends the literature by examining the viability of three goal orientation dimensions (learning, performance-approach, and performance-avoid) as predictors of complex skill acquisition. Ninety-eight males participated in 7 hours of training in order to learn a computer-based task that simulated the demands of a dynamic aviation environment. Participants completed paper-and-pencil measures of global and task-specific goal orientation as well as a test of general cognitive ability ( g). Training outcomes included declarative knowledge, knowledge structure accuracy, skill acquisition, skill retention, and skill transfer. The results indicated that both performance-approach and performance-avoid orientations explained unique variance in training outcomes beyond that explained by g. However, both performance orientations were related to the training outcomes only when operationalized as task-specific orientations, not when operationalized as global dispositions. Learning orientation was not significantly related to the training outcomes.

Undergraduate research experiences confer benefits on students bound for science, technology, engineering, and mathematics (STEM) careers, but the low number of research professionals available to serve as mentors often limits access to research. Within the context of our summer research program (BRAIN), we tested the hypothesis that a team-based collaborative learning model (CLM) produces student outcomes at least as positive as a traditional apprenticeship model (AM). Through stratified, random assignment to conditions, CLM students were designated to work together in a teaching laboratory to conduct research according to a defined curriculum led by several instructors, whereas AM students were paired with mentors in active research groups. We used pre-, mid-, and postprogram surveys to measure internal dispositions reported to predict progress toward STEM careers, such as scientific research self-efficacy, science identity, science anxiety, and commitment to a science career. We are also tracking long-term retention in science-related career paths. For both short- and longer-term outcomes, the two program formats produced similar benefits, supporting our hypothesis that the CLM provides positive outcomes while conserving resources, such as faculty mentors. We discuss this method in comparison with course-based undergraduate research and recommend its expansion to institutional settings in which mentor resources are scarce.

An alternative approach to teaching microbial diversity was designed to enhance learning of important concepts in microbiology, increase retention of content, improve microbiology-related skill sets, and positively influence student interest in and disposition toward the natural sciences.

This study analyzes the relationship of parental involvement and school adjustment among secondary students considering their school integration, school satisfaction, and prosocial disposition. The analysis also considers academic performance through the grade retention. Study sample was 1043 Spanish adolescents aged between 12 and 17 years (51.5% girls, M = 14.21, SD = 1.38). A factorial (3x2x2x2) multivariate analysis of variance (MANOVA) was applied for the outcome variables of school integration, school satisfaction, and prosocial behavior, with parental educational involvement, grade retention, sex, and age as independent variables. The results show that both parental involvement and academic performance are positively related to school adjustment. In addition, parental involvement influences adolescents’ school adjustment, regardless of academic performance, being a protective factor in that adjustment.

Disposition kinetics of [3H]palmitate and its low-molecular-weight metabolites in perfused rat livers were studied using the multiple-indicator dilution technique, a selective assay for [3H]palmitate and its low-molecular-weight metabolites, and several physiologically based pharmacokinetic models. The level of liver fatty acid binding protein (L-FABP), other intrahepatic binding proteins (microsomal protein, albumin, and glutathione S-transferase) and the outflow profiles of [3H]palmitate and metabolites were measured in four experimental groups of rats: 1) males; 2) clofibrate-treated males; 3) females; and 4) pregnant females. A slow-diffusion/bound model was found to better describe the hepatic disposition of unchanged [3H]palmitate than other pharmacokinetic models. The L-FABP levels followed the order: pregnant female > clofibrate-treated male > female > male. Levels of other intrahepatic proteins did not differ significantly. The hepatic extraction ratio and mean transit time for unchanged palmitate, as well as the production of low-molecular-weight metabolites of palmitate and their retention in the liver, increased with increasing L-FABP levels. Palmitate metabolic clearance, permeability-surface area product, retention of palmitate by the liver, and cytoplasmic diffusion constant for unchanged [3H]palmitate also increased with increasing L-FABP levels. It is concluded that the variability in hepatic pharmacokinetics of unchanged [3H]palmitate and its low-molecular-weight metabolites in perfused rat livers is related to levels of L-FABP and not those of other intrahepatic proteins.

Because of the most recent nurse shortage it has become important to determine retention factors of nursing students in the context of various aspects of college nursing programs and institutional systems. The purpose of this article is to describe the psychometric properties of a new measure that could be useful in examining nursing student retention related to the educational institution characteristics, educational processes, and individual student characteristics. The measurement instrument was conceptually designed around 4 constructs and was administered to a test group and a validation group. The dispositional construct loaded differently for each group (test group: math and science ability, confidence in the future, and confidence in ability; validation group: math and science ability, confidence in the future, self-expectation, and confidence in ability). The situational construct factored on 4 subscales (financial issues, social support, missed classes, and work issues); the institutional construct on 4 factors (peer, overall experience, diversity, and faculty); the career values construct on 5 factors (job characteristics, autonomy, caring, flexibility, and work style). Based on the results of the factor analyses and alpha reliability, evidence supported using the dispositional subscales of math and science ability, the career values subscales of job characteristics and work style, the situational subscales of work issues and financial issues, and the institutional subscales of diversity and faculty. The other potential subscales need further refinement and testing.

Purpose Although trust is considered a dyadic and bidirectional phenomenon, the majority of trust research has not considered it as such. The purpose of this paper is to contribute to closing this research gap by analyzing the influence of supervisor’s propensity to trust on salesperson trust in supervisor, considering the mediating role of servant leadership (SL). Additionally, the authors delve into the relationship between trust in supervisor and salesperson turnover by examining the moderating effect of perceived ethical climate (EC). Design/methodology/approach Information was provided by 145 salesperson–supervisor dyads from 145 companies across various industries. SEM and PROCESS procedures were used to test the proposed hypotheses. Findings The results indicate that a supervisor’s disposition to trust is positively related to employee trust in the leader via its impact on perceived SL behaviors. However and contrary to the expectations, supervisor’s propensity to trust is found to have a direct negative impact on trust in the supervisor, suggesting the presence of additional mediating variables. Finally, the trust dimension of EC moderates the negative influence of trust on salesperson turnover intentions. Research limitations/implications The findings highlight the practical benefits of fostering trust in the workplace and confirm the significant role of trust in the identification of servant leaders. In addition, the study shows that a supervisor’s disposition to trust can have a relevant effect on salesperson’s turnover intentions. Moreover, the results demonstrate the beneficial role of an ethical work climate. Originality/value This study offers insight into how to improve the retention of efficient employees and the role of trust, analyzed at a dyadic level, in this process. In addition, the findings suggest why servant leaders adopt this leadership style.

Lung uptake of technetium-labeled hexamethylpropyleneamine oxime (HMPAO) increases in rat models of human acute lung injury, consistent with increases in lung tissue glutathione (GSH). Since 99mTc-HMPAO uptake is the net result of multiple cellular and vascular processes, the objective was to develop an approach to investigate the pharmacokinetics of 99mTc-HMPAO uptake in isolated perfused rat lungs. Lungs of anesthetized rats were excised and connected to a ventilation-perfusion system. 99mTc-HMPAO (56 MBq) was injected into the pulmonary arterial cannula, a time sequence of images was acquired, and lung time-activity curves were constructed. Imaging was repeated with a range of pump flows and perfusate albumin concentrations and before and after depletion of GSH with diethyl maleate (DEM). A pharmacokinetic model of 99mTc-HMPAO pulmonary disposition was developed and used for quantitative interpretation of the time-activity curves. Experimental results reveal that 99mTc-HMPAO lung uptake, defined as the steady-state value of the 99mTc-HMPAO lung time-activity curve, was inversely related to pump flow. Also, 99mTc-HMPAO lung uptake decreased by ~65% after addition of DEM to the perfusate. Increased perfusate albumin concentration also resulted in decreased 99mTc-HMPAO lung uptake. Model simulations under in vivo flow conditions indicate that lung tissue GSH is the dominant factor in 99mTc-HMPAO retention in lung tissue. The approach allows for evaluation of the dominant factors that determine imaging biomarker uptake, separation of the contributions of pulmonary versus systemic processes, and application of this knowledge to in vivo studies. NEW & NOTEWORTHY We developed an approach for studying the pharmacokinetics of technetium-labeled hexamethylpropyleneamine oxime (99mTc-HMPAO) in isolated perfused lungs. A distributed-in-space-and-time computational model was fit to data and used to investigate questions that cannot readily be addressed in vivo. Experimental and modeling results indicate that tissue GSH is the dominant factor in 99mTc-HMPAO retention in lung tissue. This modeling approach can be readily extended to investigate the lung pharmacokinetics of other biomarkers and models of lung injury and treatment thereof.

Abstract Background Esketamine is traditionally administered via intravenous or intramuscular routes. In this study we developed a pharmacokinetic model of inhalation of nebulized esketamine with special emphasis on pulmonary absorption and bioavailability. Methods Three increasing doses of inhaled esketamine (dose escalation from 25 to 100 mg) were applied followed by a single intravenous dose (20 mg) in 19 healthy volunteers using a nebulizer system and arterial concentrations of esketamine and esnorketamine were obtained. A multicompartmental pharmacokinetic model was developed using population nonlinear mixed-effects analyses. Results The pharmacokinetic model consisted of three esketamine, two esnorketamine disposition and three metabolism compartments. The inhalation data were best described by adding two absorption pathways, an immediate and a slower pathway, with rate constant 0.05 ± 0.01 min–1 (median ± SE of the estimate). The amount of esketamine inhaled was reduced due to dose-independent and dose-dependent reduced bioavailability. The former was 70% ± 5%, and the latter was described by a sigmoid EMAX model characterized by the plasma concentration at which absorption was impaired by 50% (406 ± 46 ng/ml). Over the concentration range tested, up to 50% of inhaled esketamine is lost due to the reduced dose-independent and dose-dependent bioavailability. Conclusions We successfully modeled the inhalation of nebulized esketamine in healthy volunteers. Nebulized esketamine is inhaled with a substantial reduction in bioavailability. Although the reduction in dose-independent bioavailability is best explained by retention of drug and particle exhalation, the reduction in dose-dependent bioavailability is probably due to sedation-related loss of drug into the air.

This article presents an approach to identify Green Infrastructure (GI), its benefits and condition. This information enables environmental agencies to prioritise conservation, management and restoration strategies accordingly. The study focuses on riparian areas due to their potential to supply Ecosystem Services (ES), such as water quality, biodiversity, soil protection and flood or drought risk reduction. Natural Water Retention Measures (NWRM) related to agriculture and forestry are the type of GI considered specifically within these riparian areas. The approach is based on ES condition indicators, defined by the European Environment Agency (EEA) to support the policy targets of the 2020 Biodiversity Strategy. Indicators that can be assessed through remote sensing techniques are used, namely: capacity to provide ecosystem services, proximity to protected areas, greening response and water stress. Specifically, the approach uses and evaluates the potential of freely available products from the Copernicus Land Monitoring Service (CLMS) to monitor GI. Moreover, vegetation and water indices are calculated using data from the Sentinel-2 MSI Level-2A scenes and integrated in the analysis. The approach has been tested in the Italian Po river basin in 2018. Firstly, agriculture and forest NWRM were identified in the riparian areas of the river network. Secondly, the Riparian Zones products from the CLMS local component and the satellite-based indices were linked to the aforementioned ES condition indicators. This led to the development of a pixel-based model that evaluates the identified GI according to: (i) its disposition to provide riparian regulative ES and (ii) its condition in the analysed year. Finally, the model was used to prioritise GI for conservation or restoration initiatives, based on its potential to deliver ES and current condition.

Abstract BACKGROUND While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. OBJECTIVE To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter registry of spine surgery patients. As part of routine postoperative care, patients either ambulated on POD#0 or did not. The 90-d adverse events of length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), pulmonary embolism/deep vein thrombosis (PE/DVT), and disposition to a rehab facility were measured. RESULTS A total of 23 295 lumbar surgery patients were analyzed. POD#0 ambulation was associated with decreased LOS (relative LOS 0.83, P < .001), rehab discharge (odds ratio [OR] 0.52, P < .001), 30-d (OR 0.85, P = .044) and 90-d (OR 0.86, P = .014) readmission, UR (OR 0.73, P = 10), UTI (OR 73, P = .001), and ileus (OR 0.52, P < .001) for all patients. Significant improvements in LOS, rehab discharge, readmission, UR, UTI, and ileus were observed in subset analysis of single-level decompressions (4698 pts), multilevel decompressions (4079 pts), single-level fusions (4846 pts), and multilevel fusions (4413 pts). No change in rate of SSI or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related, enhanced-recovery-after-surgery programs.

2,4-Pentanedione (2,4-PD; CAS No. 123-54-6), an industrial chemical, was investigated for its comparative pharmacokinetics in male Fischer 344 rats by a single intravenous (IV) injection of (4.3, 43, 148.5, and 430 mg/kg), or a 6-hr nose-only inhalation exposure (400 ppm) to 14C-2,4-PD. For the IV route, the plasma concentration of 14C-2,4-PD derived radioactivity declined in a biexponential fashion. The overall form of the 14C plasma concentration-time curves and derived pharmacokinetic parameters indicated that dose-linear kinetics occurred in the IV dose range 4.3-148.5 mg/kg, but not with 430 mg/kg. Metabolism of 2,4-PD was quite rapid as the concentration of unmetabolized 2,4-PD declined steadily to undetectable after 8 hr. 14C-2,4-PD derived radioactivity was eliminated mainly as 14CO 2 and in urine. For the 4.3, 43 and 148.5 mg/kg doses 14CO2 elimination was relatively constant (36.8, 38.8 and 42.3% in 48 hr samples respectively) and greater than urinary excretion (17.9, 14.3 and 29.6% ; 48 hr specimens). At 430 mg/kg IV there was a reversal of the excretion pattern, with urine 14C excretion (54.7%) becoming greater than that for 14CO2 (27.3%). Excretion in expired volatiles and feces was small. Radiochromatograms of urine showed free 2,4-PD in the 12 hr sample, together with 7 other metabolites. Free 2,4-PD and 6 of the metabolites decreased or were not detectable in a 24 or 48 hr urine sample, but one peak (retention 7.9 min) increased progressively to become the major fraction (97%). Nose-only exposure to 400 ppm 14C-2, 4-PD produced a mean decrease in breathing rate of 20.1 %, which was constant and sustained throughout exposure, due to a lengthening of the expiratory phase of the respiratory cycle. 14C-2,4-PD was rapidly absorbed during the first 3 hr of exposure, then began to plateau, but did not reach a steady state. Postexposure elimination of 14C from plasma followed a biexponential form with a t1/2 for the terminal disposition phase of 30.72 hr. Plasma unmetabolized 2,4-PD was present throughout the whole of the exposure phase, but was significantly less than total 14C. Postexposure, plasma unmetabolized 2,4-PD declined rapidly to undetectable concentrations by 12 hr. Radiolabel excretion was approximately equivalent in urine (37.6%) and expired 14CO 2 (36.3%). Urine radiochromatograms showed a minor 2,4-PD contaminant (0.6-5.9% over 48 hr), along with 7 other peaks probably representing metabolites. As with the 148.5 mg/kg IV dose, the major metabolite peak was at 7.8 min retention, increasing from 41.1% (12 hr) to 62.8% (48 hr). Immediately postexposure, radioactivity was present in all tissues examined, but on a concentration basis (μg equiv/g) there was no preferential accumulation of 14C in any tissue or organ. On a total organ basis, highest contents were in liver and kidney, presumably related to the metabolism and excretion of 2,4-PD. By 48 hr postexposure, concentrations had decreased in all tissues except fat, presumably due to the lipophilicity of 14C residues. The profile of the plasma-time radioactivity curves, and the presence of residual radioactivity in tissues at 48 hr postexposure, suggests that a cumulative process could occur with frequent repeated exposures.

Abstract Introduction: Although there is no evidence for PEG-related safety issues with PEGylated proteins in the clinic, questions relating to the pharmacokinetics including disposition and excretion of PEG are being raised more frequently by health authorities nowadays, particularly for PEGylated proteins used chronically and/or in the pediatric population (http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2012/11/WC500135123.pdf).BAY 94-9027, a B-domain–deleted recombinant FVIII with a 60-kDa branched PEG molecule attached via a maleimide linker to an amino acid using site-specific PEGylation, is in clinical development for acute and prophylactic intravenous treatment of hemophilia A. The objective of this study was to investigate the pharmacokinetics and excretion of radioactivity (unchanged compound and radioactive metabolites) after single intravenous administration of 14C-labeled BAY 1025662 (cysteine linker-[60-kDa] PEG part of BAY 94-9027 with the 14C label covalently integrated in the linker) in male Wistar rats. Methods: The administered dose was 11 mg/kg body weight related to BAY 1025662 (approximated human lifetime dose of PEG 60 kDa resulting from treatment with BAY 94-9027). The concentrations and amounts of radioactivity in urine, feces, blood, plasma, and selected organs and tissues were investigated in order to determine the excretion via urine and feces, and the pharmacokinetics of total radioactivity and radioactive residues in the animal body. Results: After single intravenous administration of 14C-BAY 1025662 to rats, a fast initial elimination of 14C radioactivity was observed; 63.2% of administered radioactivity was excreted within the first 24 hours (51.4% in urine, 11.8% in feces). Up to day 7, 75.6% of administered radioactivity was excreted predominantly via urine. The balance/recovery of radioactivity on day 7 amounted to 99.0% in relation to the administered radioactive dose. The radioactive residue in the animals amounted to 23.4% of administered dose. The majority of the residual radioactivity was recovered in the carcass and skin, followed by liver and kidneys. The excretion of radioactivity continued at steadily decreasing levels until the end of the study. The daily radioactivity excretion decreased from 2.1% at 72 hours to 0.013% of dose at 6 months after administration of 14C-BAY 1025662. The cumulative excretion of radioactivity via urine and feces was calculated (partly interpolated) to 92.2% of the administered radioactive dose by the end of the experiment on day 168 (74.5% via urine, 17.4% via feces, and 0.294% recovered in the cage wash). The radioactivity was continuously albeit slowly eliminated from the investigated organs and tissues. The elimination half-life of radioactivity was 26 and 23 days in blood and plasma, respectively. The corresponding elimination half-lives of radioactivity were 35, 41, and 31 days in the liver, carcass, and skin, respectively. Radioactivity elimination from kidneys was biphasic with a terminal half-life of 92 days. The radioactive residues in the animals excluding the gastrointestinal tract decreased during the study from 22.5% on day 7 to 1.79% of dose at the end of the study on day 168. There was no indication for any retention or irreversible binding of radioactivity in the animal body. The total recovery of radioactivity (cumulative excretion plus residues in the animals) was 94% in relation to the administered dose at the end of the experiment on day 168. Conclusions: In this study, nearly complete excretion of the 60-kDa PEG molecule (measured as total radioactivity) could be observed, with a fast initial elimination in the first few days and a subsequent considerably slower process until the end of the observation period (6 months). These results are in agreement with recently proposed fast and slow processes for the renal excretion of large PEG and PEG proteins (Baumann, A. et al. Drug Discov Today. 2014:[Epub ahead of print, http://dx.doi.org/10.1016/j.drudis.2014.06.002]). Disclosures Baumann: Bayer Pharma AG: Employment. Schwarz:Bayer Pharma AG: Employment. Seidel:Bayer Pharma AG: Employment. Hucke:Bayer Pharma AG: Employment. Steinke:Bayer Pharma AG: Employment. Buehner:Bayer Pharma AG: Employment.

Orientation: The global skills crisis coupled with the aging workforce, rapid technological advances and changing nature of work have infringed various challenges upon organisations and employees. Media organisations in particular are affected by these trends, with retention further at risk because of the specialised and scarce skills sought and the versatility and ambiguity inherent in the nature of careers within the media industry, therefore resulting in engagement and skills retention being high on the agenda.Research purpose: The aim of the study was to explore whether employees’ age, psychological career resources and career adaptability significantly predict their work engagement and whether generational cohorts differ significantly regarding these variables.Motivation for the study: Within a retention context, it is important to gain insight into the employees’ personal career-related capabilities and dispositions as these are deemed important for driving career development and engagement levels, which, in turn, impact on the retention of talent.Research design, approach and method: A stratified random sample (N = 248) of predominantly female (63.3%) and black African people (54%) within their early career stages (80% < 45 years) was used. A cross-sectional, quantitative research design approach was followed. Stepwise regression analyses and tests for significant mean differences were performed.Main findings: The results indicated generational cohort (age), career confidence (career adaptability) and career harmonisers (psychological career resources) as significant predictors of work engagement. The Generation Y individuals had higher levels of psychological career resources (career preferences, career values and career drivers), while the Generation X individuals had higher career curiosity. The Baby Boomers showed higher levels of work engagement.Practical and managerial implications: Psycho-social career meta-capacities positively related to work engagement. It is therefore essential that these constructs are taken into account in career development and engagement practices, which, in turn, may contribute towards enhancing talent retention and employability of individuals within the media sector.Contribution: The study contributed new insights on psychological factors among generational cohorts in the media industry that predict their work engagement and possible retention.

Background and Purpose: Primary Stroke Center Certification through the Joint Commission requires specific education to patients who have sustained a stroke. Low rates of completed education were noted for stroke patients during our needs assessment. Issues with compliance included ambiguous admission diagnoses, lack of time for registered nurses to complete the education, and a deficiency in knowledge related to the Joint Commission’s certification standards. The purpose of this study was to assess the impact of a nursing stroke education team on the compliance rates of stroke education. Methods: A group of NIHSS certified nurses volunteered to be on the team, named the Team About Stroke Education and Research (TASER). These nurses received in-depth education on stroke pathophysiology and treatments, adult learning theories, and the requirements for stroke certification through the Joint Commission. By using concurrent auditing and daily rounds, TASER nurses tracked possible stroke patients within the facility and were responsible for completing the educational requirements and related documentation. A goal of 85% of completed education was set. Data was collected using retrospective audits. Results: During the six months prior to the TASER initiation, the percentage of inpatients with a discharge diagnosis of stroke who received required education was at 39.1% (9/23). During the six months after the TASER initiation, that percentage of patients who required education increased to 82.6% (19/23). TASER nurses identified 139 potential stroke patients in that 6 month period and educated a total of 68 patients, regardless of their final diagnosis, disposition, or destination. Conclusions: The TASER program showed improvements in compliance of educational requirements. Although not at the goal of 85%, further education and additional TASER nurses may increase our numbers. Future testing of the retention of the education provided may be warranted.

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality-improvement collaborative. Using MSSIC, we sought to identify the relationship between ambulation on the day of surgery (POD#0) and 90-d adverse events after lumbar surgery, specifically length of stay (LOS), urinary retention (UR), urinary tract infection (UTI), ileus, readmission, surgical site infection (SSI), PE/DVT, and disposition to a rehab facility. METHODS In 23295 lumbar surgery patients, matching was performed to ensure overlap on patient variables. Generalized estimating equations (GEE) models were run on the matched dataset to further account for patient demographics, medical history, and surgical intensity. RESULTS POD#0 ambulation was associated with decreased LOS (OR 0.83, P < .001), UR (OR 0.73, P = .008), UTI (OR 0.52, P = .001), ileus (OR 0.52, P < .001), 30-d (OR 0.84, P = .035) and 90-d (OR 0.86, P = .009) readmission, and rehab discharge (OR 0.52, P < .001) for all patients. POD#0 ambulation after single-level decompression (6244 patients) decreased LOS (OR 0.72, P < .001), UR (OR 0.73, P = .004), UTI (OR 0.43, P = .003), and rehab discharge (OR 0.18, P < .001). Ambulation after multilevel decompression (5526 patients) was associated with decreased LOS (OR 0.73, P < .001), UR (OR 0.75, P = .04), ileus (OR 0.60, P = .027), and rehab discharge (OR 0.44, P < .001). Ambulation after single-level fusion (5790 patients) decreased LOS (OR 0.85, P < .001), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.65, P = .004). Ambulation after multilevel fusion (5735 patients) decreased LOS (OR 0.88, P < .001), UTI (OR 0.60, P = .003), ileus (OR 0.51, P = .02), 30-d readmission (OR 0.77, P = .032), and rehab discharge (OR 0.59, P < .001). No change in rate of or DVT/PE was observed for patients who ambulated POD#0. CONCLUSION POD#0 ambulation is associated with a significantly decreased risk for several key adverse events after lumbar spine surgery. Decreasing the incidence of these outcomes would be associated with significant cost savings. As ambulation POD#0 is a modifiable factor in any patient's postoperative care following most spine surgery, it should be encouraged and incorporated into spine-related enhanced recovery after surgery (ERAS) programs.

The research project “Active Engagement of society in Health care policy” studies hospitals, medical personnel (doctors and nurses) and patients as the main components of Healthcare System in Georgia, targeting two regions Tbilisi and Kutaisi. The initial aim of this research project was to answer the following questions: what is the disposition, viewpoint of the hospital management representatives, medical personnel and patients towards the healthcare policy? What is the level of quality of health services for patients? What is the level of awareness? How actively are different parties involved in the health care system? Project description. The health care policy of Georgia must respond to contemporary challenges and enhance the wellbeing of the public. Given the relevance of the issue, it is important to study and analyze the public awareness towards the development of a rational health care policy that is focused on delivering competitive medical services. The main novelty of the study is to involve three different stakeholders: hospital management, medical personnel and patients in the research process. Each group has a specific interest and attitude, which in turn determines the degree and extent of their engagement, but each of them proves the need for changes. The study revealed that patients as the final recipients of medical services are informed about health funding higher than average based on data analysis from both clinics from Tbilisi and Kutaisi (50% of respondents are fully informed, 40% partially informed, and 10% are uninformed). 80% of patients receive information about medical funding directly from their medical staff at a particular place, where they receive health care service. 87.5% of hospital managers are actively involved in the process of change and collaborate with government health legislation. When it comes to both capital and on-going costs, 87.5% of the funding is spent by mobilizing the internal funds of the clinics, while only 12% comes from complex financing. 83.3% of medical personnel believe that they are involved in the process of clinic’s management and thus in healthcare policy. They generally see the changes to be implemented with the following justifications: improvement of material-technical base of hospitals 8.3%, organizational structure 16.7%, legislative 33.3%, Insurance package optimization for patients 16.7%. This mandates the need for improvement of legislative and insurance reforms. Previous studies of Georgia›s health care system, consistently demonstrated the satisfaction of beneficiaries of a universal health care program with medical services. This data strongly supports the high level of satisfaction of patients with the quality of received medical services in this study. The data analysis showed that patients› average satisfaction with the quality of medical services is 4.8 out of 5 for both cities. Despite the increasing satisfaction with quality of medical service for patients, is a subjective process, increasing the risks of medical errors in managing the treatment process. It is imperative to assess the medical risk for both the administration and medical staff. It depends on the prestige of the medical institution and staff and the continued smooth operation of the medical service. Medical risk is directly relevant to patients, so it is advisable to evaluate the impact of various factors on occupational (medical) risk management (R) using multiple regression analyzes within the current data. Exogenous factors are as follows: q1 Demand for the medical profession, q2 Competition in the professional market, q3 Satisfaction with organizational culture and management, q4 Feedback. In this case, the correlation coefficient is 0,876, the coefficient of determination is 0.767, the coefficient of correction - 0.612 and the standard deviation is 0.420. According to the F test, the equation was found to be significant at the 5% significance level. The equation: R = -2.517 + 0.195q1 + 0.575q2 + 1.195q3-1.080q4 And the standardized equation is: W = 0.117z1 + 0.375z2 + 0.717z3-0.483z4 Factors 2 and 3 in the equation are statistically significant. The signs of regression equation coefficients reflect the subjective attitude towards job risk protection that managers should consider - a competitive environment not generally, but fears of losing particular jobs due to unhealthy approaches, stress on staff, aggravates staffing, or detention or retention conditions. A successful health care setting must provide improved quality care at lower costs, easily available for patients and developing official feedback system through different settings. Methods. The design of this study was a direct interview method retrospective case control study. Participants were two hospitals in different cities (regions) of Georgia, Tbilisi and Kutaisi. One of them belongs to “Evex medical corporation” and the second one to the network of «Geo Hospitals». Three different types of questionnaires were used for each group (1. For doctors and nurses; 2. For management representatives of the hospital; 3. For patients). Total 40 questions. The most of the conclusions were statistically significant and thus their generalization was possible. The age range of the respondents was 18-70 years; 65% of the respondents were women. Considering the significant difference of each group three different interview questionnaires were used. Results. The results showed that the part of the society, namely, patients based on received data analysis are generally informed more than average level 0.681 (standard deviation). 50% of the patients say to be completely informed, only 10% of them say that they are not at all aware and 40% say to be moderately aware about the ongoing processes in Healthcare policy in Georgia. 80% of the patients are informed about the health service financing issues from medical personnel at the place of specific medical services. 87.5% of the management representatives from both regions are actively involved in healthcare policy. 88% of total participants of our project expressed their opinion and only 12% avoided commenting towards the desirable changes. For the evaluation of hospitals’ management were asked whether the management of the clinic is actively involved in health policy, or if the clinic›s leadership is trying to change something «contrary to the law», 20% of respondents are trying to be actively involved in health care legislation processes. They are resolving the issue legally, and a similar percentage of respondents are trying to solve the problem with the resources within the clinic. The difference in the number of patients about the earlier awareness regarding the quality of medical services available in the hospitals is not significant in both cities. The survey shows that most patients at both clinics have prior knowledge of the quality of medical services available at the clinic as to treatment expectation. Conclusions. A large concern regarding the Georgian health care policy amendments are strongly related with general public health. The results of this study demonstrate a potential positive willingness of three different groups to cooperate and being involved in healthcare system decision making process. This observation in addition adds strength to the continued endorsement of medical professionals that their opinion to be considered while healthcare delivery throughout the country. The findings highlight that 88% of the randomly selected respondents are open for interaction, can express their opinion regarding health care policy, insurance policy; evaluate the quality of health care and financial issues regarding health service and medication, the level of awareness and satisfaction with quality of health services. The study showed that the health care system of Georgia is developing in the directions so that no significant shortcomings are observed. It is noteworthy that reservations are very important for the active involvement of the public. Additional studies are needed to deduce an exact cause and effect relationship between public awareness and healthcare policy management.