Digital Commons Network^™

Highlights Of 2018, Arion Bank

Documents

No abstract provided.

Mongolia Product Imports From China Us$000 2011 - 2019 | Wits Data, World Integrated Trade Solution (Wits)

Documents

No abstract provided.

Annual Report And Accounts: 1 March 2018 - 28 Februrary 2019, Bank Of England/Central Bank Of The United Kingdom

Documents

No abstract provided.

Annual Report 2018, National Bank Trust Pjsc

Documents

No abstract provided.

Deposit Guarantee Schemes Data, European Union: European Banking Authority (Eba)

Documents

No abstract provided.

Annual Report 2018, Banca Monte Dei Paschi Di Siena

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No abstract provided.

Annual Report 2018, Dexia Group N.V./S.A.

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No abstract provided.

Cardiotoxicity In Hematologic Stem Cell Transplant: Keeping The Beat, Julie K. Baker

Yale School of Nursing Digital Theses

Abstract

The number of hematopoietic stem cell transplants (HSCT) performed in the U.S. and worldwide is increasing. Cardiac events have been well described in HSCT, and incidence and type of cardiac events have not changed over recent decades. This study adds to the body of evidence in describing incidence and type of cardiac events experienced by an allogeneic and autologous HSCT population at one institution from 2012-2017. Sixty-five patients (9.8%) experienced cardiac events, including atrial arrhythmia (N = 39), acute heart failure (N = 9), acute coronary syndrome (N = 7), new onset hypertension (N = 9), with a few …

A Quality Improvement School Nurse Self-Assessment Tool For School Nursing Practice, Monica Chan

Yale School of Nursing Digital Theses

School nurses play a critical role in promoting student health and supporting academic success. The goal of this project was to develop a school nurse self-assessment tool (SN-SAT) for school nurses to evaluate their school nursing practice. The self-assessment tool was constructed based on the Framework for 21st Century School Nursing Practice. A panel of school nurse experts (n=5) was asked to rate the tool on two dimensions, Importance and Relevance, on a Likert Scale for the selected chronic health condition asthma. Content Validity Indexes for each item (I-CVI), and for the overall scale (S-CVI), were computed. The final SN-SAT …

Same Pay For The Same Service: Advocacy Efforts In Washington State, Justin Gill

Yale School of Nursing Digital Theses

Same Pay for the Same Service: Advocacy Efforts in Washington State

The submission criteria for this article at "The Nurse Practitioner" does not include an abstract.

Medication Access Using An Evidence-Based Adaptive Transitional Care Guidance Tool For Planned Release Of Older Inmates, Erin Iturriaga

Yale School of Nursing Digital Theses

The aging population is growing faster in the correctional system than in the overall U.S. population. Yet, an effective geriatric transitional care process is not available for older persons released from jail. This article documents the development and results of an evidence-based, adaptive transitional care tool guided by Meleis’ transitions theory to improve access to medications for older persons released from jail. Three sources of evidence were used to develop the tool: different categories of literature, expert panel determination of the tool’s domain and content relevance and importance, and a focus group interview of five people working in a transitions …

Neighborhood Walking Tours For Physicians-In-Training, Jeremiah Cross

Yale Medicine Thesis Digital Library

Social and economic factors have a profound impact on the health of patients served by physician residents. However, education about these factors has not been consistently incorporated into residency training. Experiential education, such as neighborhood walking tours, may help physician residents learn about the social determinants of health and community resources available to patients.

Using a community-based participatory research (CBPR) approach, we implemented a neighborhood walking tour curriculum for physician residents and faculty in the Pediatrics, OB/Gyn, Emergency Medicine, Primary Care and Traditional Medicine programs. In 2017, 86 individuals participated in the tours, 81 physician residents and 5 faculty. Both …

Methods For The Visualization Of Placental Vasculature In Fetoscopic Surgery, Praneeth Sadda

Yale Medicine Thesis Digital Library

Twin-to-twin transfusion syndrome is a potentially fatal disease of placental vasculature in twin pregnancies. It is treated with fetoscopic laser photocoagulation surgery, a procedure in which a surgeon uses an endoscope to find and cauterize abnormal vascular anastamoses on the placental surface. However, even after surgery, mortality remains as high as twenty to forty-eight percent, largely due to anastamoses being missed during the operation. Many technical challenges contribute to anastamoses being missed, including poor endoscopic image quality and a limited field of view. Any tools capable of addressing these challenges would be clinically valuable. This thesis presents the design and …

Evaluation Of The Mechanisms Of Anti-Cancer Immune Responses, Noel Turner

Yale Medicine Thesis Digital Library

Metastatic melanoma historically carries a grim prognosis, with a median survival of 9 months and a long-term survival rate of 10%. Melanoma is highly immunogenic, and the development of immunotherapies has dramatically changed the landscape of metastatic melanoma treatment. To study the immune mechanisms engaged by these therapies, the Bosenberg lab developed YUMMER, an immunogenic mouse melanoma line that forms tumors when injected into mice. This and other immunogenic murine cancer models were used to demonstrate that B cell depletion does not impair the anti-PD-1-induced anti-tumor immune response in mice. In addition, supplementing immune checkpoint inhibition with therapies targeting myeloid …

Effects Of Bail-Ins European Banks, Tom Remue

Documents

No abstract provided.

Counterfactuals With Latent Information, Dirk Bergemann, Benjamin Brooks, Stephen Morris

Cowles Foundation Discussion Papers

We describe a methodology for making counterfactual predictions when the information held by strategic agents is a latent parameter. The analyst observes behavior which is rationalized by a Bayesian model in which agents maximize expected utility given partial and differential information about payoff-relevant states of the world. A counterfactual prediction is desired about behavior in another strategic setting, under the hypothesis that the distribution of and agents’ information about the state are held fixed. When the data and the desired counterfactual prediction pertain to environments with finitely many states, players, and actions, there is a finite dimensional description of the …

Endogenous Beliefs And Institutional Structure In Competitive Equilibrium With Adverse Selection, Gerald David Jaynes

Cowles Foundation Discussion Papers

I model financial markets that structure decision-making into discrete points separating contract offers, applications, and acceptance/denial decisions. Endogenous beliefs about applicants’ risk types emerge as the institutional process extracts private information allowing uninformed firms to infer risk qualities by comparing applications of many consumers. Endogenous beliefs and low-risk consumer behavior render truthful disclosure of transactions incentive compatible supporting a unique equilibrium robust to cream-skimming and cross-subsidizing deviations, even under Hellwig’s “secret” policy assumption. In equilibrium each type demands low-risk’s optimal pooling policy and high-risk supplement to full coverage at fair-price. Nonpassive consumers’ belief firms are sequentially rational necessary for equilibrium; …

Misinterpreting Others And The Fragility Of Social Learning, Mira Frick, Ryota Iijima, Yuhta Ishii

Cowles Foundation Discussion Papers

We exhibit a natural environment, social learning among heterogeneous agents, where even slight misperceptions can have a large negative impact on long-run learning outcomes. We consider a population of agents who obtain information about the state of the world both from initial private signals and by observing a random sample of other agents’ actions over time, where agents’ actions depend not only on their beliefs about the state but also on their idiosyncratic types (e.g., tastes or risk attitudes). When agents are correct about the type distribution in the population, they learn the true state in the long run. By …

Counterfactuals With Latent Information, Dirk Bergemann, Benjamin Brooks, Stephen Morris

Cowles Foundation Discussion Papers

We describe a methodology for making counterfactual predictions when the information held by strategic agents is a latent parameter. The analyst observes behavior which is rationalized by a Bayesian model in which agents maximize expected utility, given partial and differential information about payoff-relevant states of the world. A counterfactual prediction is desired about behavior in another strategic setting, under the hypothesis that the distribution of and agents’ information about the state are held fixed. When the data and the desired counterfactual prediction pertain to environments with finitely many states, players, and actions, there is a finite dimensional description of the …

Accuracy In Reporting Of Kentucky Certified Nurse-Midwives As Attendants In Birth Registration Data, Kendra Marie Chesney Adkisson

Yale School of Nursing Digital Theses

Abstract

Introduction: Birth certificate data is used nationally to determine healthcare policy, allocation of funds, and to demonstrate the legitimacy and value of Certified Nurse-Midwives (CNMs) in maternal and neonatal outcomes. However, the validity of birth certificate data is questionable, in part because of the data collection process. This data is particularly crucial for midwife-attended births as the correct birth attendant is not always accurately identified. The purpose of this project was to examine the number of CNM reported births as compared to the number recorded by the Kentucky office of vital statistics and to look at the process used …

Development And Implementation Of A Simple Wound Care Guideline For Minor Skin Lesions: A Quality Improvement Project, Alexandra Bates

Yale School of Nursing Digital Theses

Purpose: The purpose of this QI project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline for minor skin lesions.

Participants and Setting: This wound care guideline was developed for nurses working on inpatient adult acute care units. The setting was a large community hospital in southwest Minnesota.

Approach: The guideline was validated for its clarity and appropriateness by external and internal expert wound care nurses. It was implemented through in-person unit rounding on the nursing units, distribution of badge cards with the guideline, and a required online education …

Implementing Real-Time Computerized Clinical Decision Support During Trauma Resuscitations: Lessons Learned From Simulation., Nathan Arnold Miller Christopherson

Yale School of Nursing Digital Theses

Through the combination of clinical expertise, research, and patient values evidence-based practice (EBP) is becoming the new standard of patient care. Despite the main benefits of EBP medical providers are hesitant to implement based on a multitude of barriers. In order to increase adoption of EBP we need to develop deliver systems that bring best evidence in an easy to use format to the bedside.

We tested the implementation of a computerized clinical decision support documentation platform during trauma team resuscitations. The simulation sessions were geared to help identify opportunities for improvement in our implementation methodology.

During the simulation sessions …

How The Five Rights Are Wrong: Development Of A Nursing Medication Safety Science Curriculum, Melissa Ann Davis

Yale School of Nursing Digital Theses

Medication errors, now thought to be four times greater than previous estimates, pose a serious threat to nurses, patients, and health care institutions. Current nursing education lacks any coherent medication safety framework other than the classic “Five Rights” construct. This project piloted an educational intervention with senior nursing students based on systems-thinking safety principles. Students evaluated the learning experience positively and improved pre- to post-testing scores by 74%. This study demonstrates students’ ready acceptance and comprehension of systems thinking medication safety theory, an alternative to the “Five Rights” construct.

Comparison Of Surgeon Perception Of Preoperative Patient Risk With The Acs Nsqip® Surgical Risk Calculator, Jeffrey Scott Cudd

Yale School of Nursing Digital Theses

Introduction

Surgeon perception of surgical risk varies. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP®) Surgical Risk Calculator (SRC) estimates risk of postoperative outcomes and can assist with communicating risks to patients preoperatively. We compared surgeon risk estimates with calculations of risk from the SRC.

Methods

In this project in 2 medical centers, 10 surgeons completed a tool in which they estimated the risk of complications for patients undergoing elective surgical procedures. A NSQIP-trained reviewer determined SRC estimates for the same patients. Agreement was determined using Bland-Altman and Lin’s concordance statistics.

Results

In the evaluation of …

Nurse Practitioner Reimbursement Parity: An Advocacy Strategy For Washington State, Justin Gill

Yale School of Nursing Digital Theses

Nurse practitioners (NP) play a vital role in the United States health care system. Nurse practitioners belong to a category of Advanced Practice Registered Nurses (APRN). APRNs in Washington State, licensed as Advanced Registered Nurse Practitioners (ARNP), are able to practice without the requirement of physician supervision or oversight. This facilitates NP practice ownership. NPs are qualified, autonomous, clinicians that can help address the primary and mental health care needs in Washington State. Washington State, unlike Oregon, does not require third-party insurers to reimburse NPs the same rate for the same services provided by a physician. This has financial implications …

Veteran Suicide Risk Reduction Through Targeted Dissemination Of An Easy To Use Risk Screening Instrument, Joshua Faucett

Yale School of Nursing Digital Theses

On August 3, 2016, the United States Department of Veterans Affairs Office of Suicide Prevention published the most comprehensive analysis of Veteran suicide in the nation’s history. The Office of Suicide Prevention examined more than 55 million Veteran healthcare records from 1979 to 2014 from all 50 states and four territories (Office of Suicide Prevention, 2016). The study results found that although Veterans account for only 8.5% of the U.S. adult population, they are responsible for 18.5% of all U.S. suicides (Office of Suicide Prevention, 2016). After adjusting for differences in age and gender, the risk for suicide was 21% …

An Educational Module To Improve Pre-Hospital Stroke Assessment: Stroke Mimics And The Field Assessment Stroke Triage For Emergency Destination (Fast-Ed) Scale, Susan Elizabeth Hunt

Yale School of Nursing Digital Theses

ABSTRACT

Introduction: Studies show that up to 30% of acute stroke patients brought to the emergency department (ED) are diagnosed with a stroke mimic. With more stroke systems adopting a prehospital large vessel occlusion (LVO) stroke scale that includes bypass protocol, it is imperative that emergency medical service (EMS) personnel be educated on how to implement the scale, identify stroke mimics, and accurately determine the time of last known well. Studies show that LVO stroke scales demonstrated low specificity when scored by EMS personnel, as compared to those scored by physicians. In 2018 the Massachusetts Office of EMS updated the …

Creation Of An Interdisciplinary Evidence-Based Advocacy Tool: Promoting Medicaid Reimbursement For Pasteurized Donor Milk For Very Low Birth Weight Neonates, Christopher Schmaltz

Yale School of Nursing Digital Theses

An interdisciplinary approach to remove cost barriers associated with full utilization of pasteurized donor human milk in the neonatal intensive care unit. This scholarship produced an evidence-based advocacy tool which allows the user to enter state-specific data to demonstrate the fiscal advantages of implementing pasteurized donor human milk reimbursement policies from a Medicaid payor perspective.

Supporting Breastfeeding Among Women Residing In Homeless Shelters, Tracy Renee Webber

Yale School of Nursing Digital Theses

In general, homeless women face many challenges including intimate partner violence, abuse history, mental illness, chemical dependence, alcohol abuse, smoking, medical co-morbidities, lack of permanent address, or any combination of the aforementioned (Vijayaraghavan, et al., 2012). Adding pregnancy and a newborn into shelter living further heightens the vulnerability for this population. Women who reside in homeless shelters are likely to have minimal access to breastfeeding support services and thus low rates of sustained breastfeeding. The purpose of this DNP capstone project is to examine current breastfeeding support within homeless shelters in Brooklyn, New York by conducting assessments of services through …

The Development Of An Evidence-Based Anti-Emetic Tool For The Management Of Post-Operative Nausea And Vomiting In Patients At High Risk For Qt Prolongation And Patients Taking Neurotransmitter Modulating Medications, Nicole Danielle Mancini Hymel

Yale School of Nursing Digital Theses

Abstract

Peri-operative care providers have a myriad of medication options when developing and implementing a plan for the management of post-operative nausea and vomiting (PONV). However, the provider must be aware of the potential side effects, complications, and interactions of those medications, especially when managing high-risk populations. While a peri-operative antiemetic algorithm exists for the management of PONV in the general population,1 an evidence-based antiemetic tool has not been developed for patient populations at risk for prolonged QT interval or patients who are routinely taking neurotransmitter modulating medications. Safe practice recommendations exist but are scattered throughout the literature. The goal …