Siena College

The COmmunicating Narrative Concerns Entered by RNs (CONCERN) early warning system (EWS) uses real-time nursing surveillance documentation patterns in its machine learning algorithm to identify deterioration risk. We conducted a 1-year, multisite, pragmatic trial with cluster-randomization of 74 clinical units (37 intervention; 37 usual care) across 2 health systems. Eligible adult hospital encounters were included. We tested if outcomes differed between patients whose care teams were and patients whose care teams were not informed by the CONCERN EWS. Coprimary outcomes were in-hospital mortality (examined as instantaneous risk) and length of stay. Secondary outcomes were cardiopulmonary arrest, sepsis, unanticipated intensive care unit transfers and 30-day hospital readmission. Among 60,893 hospital encounters (33,024 intervention; 27,869 usual care), intervention group encounters had 35.6% decreased instantaneous risk of death (adjusted hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.53–0.78; P < 0.0001), 11.2% decreased length of stay (adjusted incidence rate ratio, 0.91; 95% CI, 0.90–0.93; P < 0.0001), 7.5% decreased instantaneous risk of sepsis (adjusted HR, 0.93; 95% CI, 0.86–0.99; P = 0.0317) and 24.9% increased instantaneous risk of unanticipated intensive care unit transfer (adjusted HR, 1.25; 95% CI, 1.09–1.43; P = 0.0011) compared with usual-care group encounters. No adverse events were reported. A machine learning-based EWS, modeled on nursing surveillance patterns, decreased inpatient deterioration risk with statistical significance. ClinicalTrials.gov registration: NCT03911687.

Nurses have been described as particularly adept at identifying and utilizing workarounds to overcome poor system designs that disrupt workflows. Workflows and workarounds are not limited to directly observable patient care activities; they also occur within documentation activities and can be modeled using metadata (data about data) from clinical information systems. Health systems engineering is an approach to effectively implement a learning health system that drives more efficient and safer care by adapting and aligning individual structures (e.g., applications) and processes (e.g., workflows) to optimize outcomes within a “system of systems”. This chapter will outline three broad approaches that can be triangulated within a systems engineering framework to reengineer nursing and patient care workflows to overcome information silos by actively learning from health system safety information gaps and workarounds. Systems engineering can be applied to a range of healthcare processes leveraging a five-phase model of problem analysis, design, development, implementation, and evaluation. The three aforementioned approaches can be applied during the various phases to model workflow, data and information flow, and to support the development, integration, and optimization of health IT applications. In this chapter we present use cases of pragmatic applications grounded in theoretical and methodological approaches and situated within a systems engineering framework that demonstrate the iterative nature of health IT evaluation. We also highlight the complexity of nursing and patient care workflows and substantiate that even well-designed systems that adequately address sociotechnical dimensions as part of the development process, require continued attention to workflow during and after implementation. To achieve a learning health care system that optimizes workflow, it requires nursing and data science and systems engineering domain expertise and working collaboratively throughout the system life cycle to contextualize clinical analyses and to successfully convert data into knowledge.

This note examines the extensive use of economic sanctions in US foreign policy, a development that has grown extensively in the last four decades without regard to presidential leadership. The issues surrounding sanctions include their definition, history, and effectiveness. Distinctions between kinds of sanctions are noted, as well as the consequences of their use, along with difficulties in employing sanctions. Finally, a moral assessment of the practice of sanctions is offered.

The decorator worm Diopatra cuprea Bosc, 1802 (Annelid; Polycheate; Onuphidae) is an ecosystem engineer within high-salinity estuaries of the southern and eastern United States. A previous study revealed five morphologically cryptic mitochondrial lineages across its broad geographic distribution. Here, we explore mitonuclear concordance of these lineages using single nucleotide polymorphisms (SNPs) genotyped with RADseq. We genotyped 3,162 SNPs from 233 D. cuprea and detected four deep lineages in the nuclear genome: a northern US clade (Massachusetts), a single nuclear clade within mid-Atlantic populations (i.e., Virginia south through northeastern Florida), a southeastern Florida clade, and a Gulf of Mexico clade. There was mitonuclear concordance within most individuals for three lineages, while two mitochondrial lineages were detected in a single mid-Atlantic nuclear lineage. Thus, there appear to be four cryptic lineages of D. cuprea that suggest four distinct species that rarely hybridize. Within the mid-Atlantic lineage, we detected increasing genetic isolation of populations with increasing geographic distance, a pattern consistent with low dispersal of D. cuprea larvae. Cryptic diversity within the D. cuprea complex is consistent with other common and geographically widespread annelid and Diopatra species that are now being revealed using high-throughput sequencing.

The incidence of colorectal cancer (CRC) in younger adults has risen by about 1–2% annually in the past decade. TikTok has become a popular venue for the discussion of health information among young adults. This study analyzed the top 85 most-liked TikToks under the search terms “early colon cancer” and “young adult colon cancer,” to evaluate their educational value. Data on the post uploader, content, analytics, and mentioned tips/symptoms were collected. Two independent researchers rated the quality of each video using a global quality score (GQS). The videos analyzed had a total of over 37 million views. Among them, 16.47% highlighted how misinformation contributed to delayed diagnoses, yet only 2.35% specifically educated viewers about such misinformation. Provider-posted content had higher GQS ratings than non-provider content (p < 0.05), indicating better quality, although total views were higher for non-provider content. The GQS did not differ significantly between highly viewed (> 100,000 views) and lower-viewed (≤ 100,000 views) videos. Our results highlight that TikTok is a key platform for engaging young adults about rising CRC rates, though increased expert engagement is needed to address current gaps in combating misinformation and promoting high-quality educational content.

Objectives Amyloid fibrils are misfolded proteins that self-assemble to form insoluble, elongated, β-sheet structures. These fibrils are linked with the progression of neurodegenerative diseases like Alzheimer's Disease and metabolic disorders such as Type II diabetes. A range of molecules have shown the ability to impede the formation of these fibrils, often by acting on the monomeric and oligomeric forms of the protein. Our work focuses on the inhibitory effect of curcumin, gallic acid and mangiferin on the formation of amyloid fibrils. Materials and methods Bovine insulin was used as a model system for amyloid formation by lowering the pH at 60 °C, and several different small molecules were used to test inhibition. Samples were analyzed using Atomic Force Microscopy (AFM) in a liquid environment, as well as Congo Red and Thioflavin T assays. Results We have been able to observe significant inhibition of amyloid fibril formed from insulin by these compounds as well as observe beginning stages and the morphology of fibrils. Mangiferin, gallic acid, and curcumin were all shown to slow down fibril formation, though by 5 days fibrils have started to form in the gallic acid solution. After 7 days, solutions containing curcumin or mangiferin still show no strong evidence of structured fibrils. Conclusion Gallic acid, curcumin and mangiferin are all molecules that have inhibitory effects on amyloid formation using insulin as a model system, with gallic acid being somewhat less effective than the other two. The AFM technique used to image fibrils was performed in an environment that more closely resembles in vivo conditions than air dried samples.

This study examines the relationship between gender-related aid and legal frameworks governing women’s economic opportunities. Using data from 116 countries (2009–2022), we analyze how significant (SGRA) and principal (PGRA) gender-related aid influence the Women, Business, and Law (WBL) Index, which measures women’s access to employment, credit, and entrepreneurship. Results from fixed-effects models show that SGRA consistently improves WBL Index components, while PGRA significantly impacts marriage, parenthood, and mobility regulations, with modest effects on workplace and entrepreneurship measures. PGRA substantially affects marriage, parenthood, and mobility regulations while demonstrating more modest impacts on workplace conditions and entrepreneurship measures. These observations underscore the complexity of addressing gender inequality and the necessity of targeted, multifaceted approaches to overcome legal restrictions, entrenched social norms, and economic barriers. The research offers valuable insights for policymakers and donors on the transformative potential of gender-mainstreamed aid initiatives in fostering a more equitable world.

Cooperative behavior by nonrelatives is an evolutionary puzzle, because costs of cooperation are often strong while selective factors favoring cooperative groups remain unclear. In some populations of the seed harvester ant Pogonomyrmex californicus, unrelated queens form groups at colony founding (pleometrosis), whereas in other populations, colonies are initiated by single queens (haplometrosis). We tested the hypothesis that energetic savings of grouping contribute a benefit that may enhance queen success during colony founding and early growth for pleometrotic colonies. We measured metabolic rates and locomotor activity of individuals or pairs of freshly collected, newly mated P. californicus queens from pleometrotic and haplometrotic populations. Population source did not significantly affect metabolic rates, but paired queens from both populations had mass-specific metabolic rates only 86% of those of individual queens. The metabolic effect of grouping was not explained by differences in locomotion. To test whether this degree of energetic saving could be biologically significant, we assessed metabolic rate, body mass, and egg production for pleometrotic pairs at four time points of colony founding and compared the energetic content of stored lipid to energy use up to the point of worker emergence. Metabolic rates dropped over time for queens, as did body mass, and gas exchange switched from continuous to discontinuous, suggestive of metabolic suppression. Total joules required for queens to reach the worker emergence stage were 1.5 times the energy content of stored lipids, consistent with the need for foraging for these queens, and supporting the hypothesis that energetic savings of grouping can be beneficial by extending energetic stores and reducing the need for risky foraging.

Social innovation has been widely studied as an approach to mitigate wicked problems and their associated grand challenges. Even so, there are a myriad of location‐specific hurdles to successful formation, design, implementation, and scaling that require the expertise and integration of local partner knowledge. In this regard, there is a dearth of research identifying the impact of such stakeholder empowerment when potential solutions, ideas, and projects are forming—particularly in an international context. To address this gap, we used a qualitative case study approach with semi‐structured interviews to follow projects through the initial, developmental, and implementation/termination periods of the social innovation journey. Sample projects include solar power technology for off‐grid rural populations, the development of a mobile app to facilitate the movement of time‐sensitive goods, and the development of a compostable toilet to replace pit latrines. The findings indicate the stakeholder empowerment criteria of (1) collective action and (2) the reconfiguration of social relations are most impactful during the initial idea gestation component of the journey and serve as an early signal of project survival or termination. In addition, they are also most impactful during the setbacks and criteria shift components, wherein local partners signal practical constraints from institutional voids that must be addressed alternatively. This research provides a foundation for future studies on the early formation of social innovations and their likelihood of survival with stakeholder empowerment.

In my teaching of canonical nineteenth century British literature, I strive to educate students not only about the background of and context for a literary work, but also to foster in them the ability to read critically and argue persuasively, not to mention to write effectively. However, an important component is a nuanced attention to diversity and difference. In a British Romanticism class with units devoted to otherness such as gender and socioeconomic disparity I incorporate a unit dedicated to the Haunted Summer and monstrosity. Critically discussing Mary Shelley’s Frankenstein (1818) and John Polidori’s “The Vampyre” (1819) provides an avenue to explore less frequently taught texts that examine horror, race, and slavery: Uriah Derick D’Arcy’s “The Black Vampyre” (1819) and Matthew “Monk” Lewis’ Journal of a West-India Proprietor (1834). By including the vampire in this unit, I am able to entice the students into their learning as active citizens. This chapter demonstrates the ways in which the vampire image, embedded in a course focused on a literary time period, offers the perfect doorway through which to teach difference, marginalization, and a host of core identity issues.

In this study, the effects of processing temperatures of indium nanoparticles (In NPs) on the thermal conductivity (κ) of an organic phase change material (PCM) were investigated. 1-octadecanol (1-OD) also known as stearyl alcohol, with chemical formula C18H38O was selected as the organic PCM. Surface of Indium nanoparticles are functionalized with polyvinylpyrrolidone (PVP) to promote particles dispersion in 1-OD medium. Experimental analysis showed that for the In NPs/1-OD composite phase change material (CPCM) with a ~12 vol.% (~55 wt.%) of In NPs loading, specific melting latent heat (Lm) of the mixture is 103.1 J/g (~41.5% Lm,1-OD). This value is proportional to weight % loading of 1-OD (~45 wt.%) in the mixture. The κ versus processing temperature graph showed a turning point between 100 °C and 110 °C reaching a κ = 2.56 ± 0.07 W/mk at this processing temperature range. This is ~ 6.74-fold higher than κ of the 1-OD organic PCM matrix at 0.38 ± 0.01 W/mK. This is due to formation of high aspect ratio (length/diameter) conductive network pathways of In NPs in 1-OD organic PCM.

The standard introductory course in microeconomics presents a sophisticated set of tools for understanding the dynamics of markets, which are of central importance in all contemporary societies. Unfortunately, most textbooks for this course inadequately address, and frequently distort, the following six issues critical to students’ understanding of economic society: the nature of work and its relation to utility; social interdependence in decision-making; economic growth as the principal objective of modern socio-economic systems; the overall importance of market externalities; the pervasiveness of market power and its impact on consumers; and the relationship between property rights and economic justice. The outcome is that students are often left with the impression that unfettered markets necessarily deliver economic efficiency and just outcomes, resulting in a pedagogy that serves as ideology, legitimating prevailing and unequal social conditions. This article is intended to highlight these ideological aspects of the standard microeconomics curriculum and to offer professors some relatively simple strategies for addressing these issues without the need to significantly alter the curriculum.

Frailty refers to a state of increased vulnerability to mortality and other adverse outcomes as a consequence of age-related decline in physiologic reserve and function. Comparative biomedical scientists are relied upon to innovate approaches to enhance understanding of the similarities and differences between humans and other animal species that can impact healthy aging. The research aim of this study was to develop a clinical frailty index (FI) in the Exceptional Aging in Rottweilers Study (EARS) and test its ability to predict all-cause mortality in elderly dogs. EARS is an ongoing lifetime cohort study of pet dogs with extreme longevity living in North America. Living 30% longer than the breed average, these dogs represent the canine counterpart to human centenarians. A 34-item FI (EARS-FI) was constructed to assess deficit accumulation using clinical data collected by telephone interviews with owners of 93 dogs with extreme longevity. Health deficits across multiple domains, including cognitive and sensory, cardiovascular and endocrine, and mobility, were included. The association between EARS-FI and subsequent mortality was tested in Kaplan-Meier survival analysis and in age-adjusted Cox proportional hazard models. Median (interquartile range) EARS-FI was 0.43 (0.38–0.50), and the estimated frailty limit was 0.68, consistent with data reported in humans with extreme longevity. Frailty index increased with increasing chronological age (p < 0.001). Deficit accumulation was significantly associated with increased mortality risk. Age-adjusted hazard ratio for mortality per 0.01 unit increase in FI was 1.05 (95%CI, 1.02–1.08; p = 0.001). This work provides the first demonstration of a strong association between frailty and mortality risk in pet dogs with extreme longevity. Notably, EARS-FI showed key features observed in the evaluation of frailty in aging human populations: heterogeneity, increase with chronological age, and estimated limit of <0.7. Validated here as a predictor of mortality in aged pet dogs, EARS-FI offers a useful tool for further comparative analyses of the linkages between deficit accumulation, mortality, and other adverse health outcomes.

Gene model for the ortholog of Insulin-like peptide 5 ( Ilp5 ) in the D. ananassae May 2011 (Agencourt dana_caf1/DanaCAF1) Genome Assembly (GenBank Accession: GCA_000005115.1 ) of Drosophila ananassae . This ortholog was characterized as part of a developing dataset to study the evolution of the Insulin/insulin-like growth factor signaling pathway (IIS) across the genus Drosophila using the Genomics Education Partnership gene annotation protocol for Course-based Undergraduate Research Experiences.

Background The internet and communication devices are changing the ways in which society plans for death and remembers loved ones. The ‘Digital Death Survey’ has measured and reviewed attitudes and behaviours in areas relating to death and the internet since 2014. Aims This year’s dataset will be compared with previous historical, Digital Death Survey data. This will allow professionals to better understand changing attitudes and behaviours. Awareness and understanding might lead to organisational change, individual empowerment and better patient, family and community care. Methods International survey by the Digital Legacy Association (UK) and Siena College (USA). The survey has been ethically reviewed and approved by Siena College’s appointed Institutional Review Board guardian. Results Published in November 2024 and first shown at Hospice UK’s Conference. Conclusion Insights and conclusions will be drawn from both the data and quantitative trends. The presentation will look ahead and make predictions for the future and ‘dying in tomorrow’s world’.

Gene model for the ortholog of Thor ( Thor ) in the D. yakuba May 2011 (WUGSC dyak_caf1/DyakCAF1) Genome Assembly (GenBank Accession: GCA_000005975.1 ) of Drosophila yakuba . This ortholog was characterized as part of a developing dataset to study the evolution of the Insulin/insulin-like growth factor signaling pathway (IIS) across the genus Drosophila using the Genomics Education Partnership gene annotation protocol for Course-based Undergraduate Research Experiences.