VESAS: a solution to seasonal fluctuations in emergency department census

STUDY OBJECTIVE: To design and implement a plan for emergency department staffing and additional space to reduce waiting time and the rate of patients leaving without being seen during the viral epidemic season. METHODS: The study was conducted in the ED of a tertiary care children's hospital. We compared 24,657 children who presented for care between November 1996 and March 1997 (VESAS plan enacted) with 24,012 children who presented for care during the same period in the preceding year. VESAS (Viral Epidemic Supplemental Attending and Staff), an additional team of personnel, was on call for the viral epidemic season and was called to work if the hourly ED census that day was 25% or more of the past year's average hourly patient volume. Extra examination rooms were made available in space contiguous to the ED. Interval data, "left without being seen" rates, and ED census were monitored and compared with the previous year's data. RESULTS: The VESAS team was used for 32% of the days during the 4-month intervention period. The left-without-being-seen rate was reduced by 37% (95% confidence interval, 33% to 41%). The average time from arrival to consultation with a physician was decreased by 15 minutes (95% confidence interval, -10 to -20) for all patients. Waiting times were most markedly reduced for less acutely ill or injured patients, although a modest decrease was also observed in patients with more severe illnesses or injuries (-10 minutes). The percentage of lesser-severity patients seen in an urgent care area was increased from 35% to 51%. CONCLUSION: VESAS, a plan for providing space and personnel to handle an increased volume of patients that can be activated on the basis of hourly census data, was successful as judged by waiting times and percentage of patients who left without being seen.     

Tomato Prf is a member of the leucine-rich repeat class of plant disease resistance genes and lies embedded within the Pto kinase gene cluster

In tomato, resistance to Pseudomonas syringae pv. tomato (Pst) strains expressing the avirulence gene avrPto requires the presence of at least two host genes, designated Pto and Prf. Here we report that Prf encodes a protein with leucine-zipper, nucleotide-binding, and leucine-rich repeat motifs, as are found in a number of resistance gene products from other plants. prf mutant alleles (4) were found to carry alterations within the Prf coding sequence. A genomic fragment containing Prf complemented a prf mutant tomato line both for resistance to Pst strains expressing avrPto and for sensitivity to the insecticide Fenthion. Prf resides in the middle of the Pto gene cluster, 24 kb from the Pto gene and 500 bp from the Fen gene.     

Learned helplessness, test anxiety, and acknowledgment of contingencies.

72 undergraduates designated as high or low test anxious (Test Anxiety Questionnaire) received either controllable of uncontrollable noise in a typical helplessness induction. Half of them subsequently received an acknowledgment of contingencies in the induction task, and the other half did not. An anagram task was then administered. Test anxiety theory successfully predicted group differences in anagram performance: Only high-test-anxious Ss were debilitated by the helplessness induction. The effects of providing acknowledgment of contingencies proved ambiguous, but this may have been due to the wording of the acknowledgment and the susceptibility of high-test-anxious Ss to social dimensions of the task situation. Because of differences in terminology, learned helplessness theory has failed to take into account a large body of literature that has similarly employed experimenter-induced failure, and there are numerous competing explanations for impairments following a helplessness induction. Test anxiety theory suggests that the deficits underlying impaired performance are likely to be attentional in nature. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learned helplessness as experimenter-induced failure and its alleviation with attentional redeployment.

When it is recognized that laboratory studies of learned helplessness with human Ss are basically studies of experimenter-induced failure, the relevance of numerous studies of failure induction and of the theoretical models that generated them becomes apparent. The present study with 108 undergraduates adopted the assumption that cognitive interference associated with anxiety is the source of the performance decrements observed in helplessness studies. For susceptible Ss, failure experiences elicit a task-irrelevant, negative focus on self. As predicted from such a model, attentional redeployment in the form of an imagination exercise eliminated the impairment of performance that typically follows a helplessness induction. However, it was found that the effectiveness of the exercise depended on provision of a rationale to Ss. As predicted, it was found that Ss who received the exercise and rationale in the absence of a failure induction became debilitated, although this effect was only marginally significant. Results are discussed in terms of a cognitive-attentional interpretation of learned helplessness studies, and the likely role of demand characteristics is noted. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Human Resource Management in Multinational Enterprises: Evidence From a Late Industrializing Economy

This paper examines the extent to which human resource management (HRM) practices in multinational enterprises (MNEs) from a small, late developing and highly globalized economy resemble their counterparts from larger, early industrializing countries. The paper draws on data from a large-scale representative survey of 260 MNEs in Ireland. The results demonstrate that there are significant differences between the HRM practices deployed in Irish-owned MNEs and that of their US counterparts but considerable similarity with UK firms. A key conclusion is that arguments in the literature regarding MNEs moving towards the adoption of global best practices, equating to the pursuance of an American model of HRM, were not obvious. The study found considerable variation from ‘US practices’ amongst indigenous Irish MNEs.     

An investigation into modification of personality hardiness in staff nurses

Responsibilities of nurse educators include assisting nurses to adjust to a rapidly changing healthcare environment and demonstrating how these efforts are effective. In this article, the authors describe a study that measures the effects of teaching hardiness, a characteristic encompassing commitment, control, and challenge, to newly employed hospital nurses. The authors believe the study results indicate that instruction in hardiness is possible and may have an impact on morale.