Enabling genomic island prediction and comparison in multiple genomes to investigate bacterial evolution and outbreaks.

Outbreaks of virulent and/or drug-resistant bacteria have a significant impact on human health and major economic consequences. Genomic islands (GIs; defined as clusters of genes of probable horizontal origin) are of high interest because they disproportionately encode virulence factors, some antimicrobial-resistance (AMR) genes, and other adaptations of medical or environmental interest. While microbial genome sequencing has become rapid and inexpensive, current computational methods for GI analysis are not amenable for rapid, accurate, user-friendly and scalable comparative analysis of sets of related genomes. To help fill this gap, we have developed IslandCompare, an open-source computational pipeline for GI prediction and comparison across several to hundreds of bacterial genomes. A dynamic and interactive visualization strategy displays a bacterial core-genome phylogeny, with bacterial genomes linearly displayed at the phylogenetic tree leaves. Genomes are overlaid with GI predictions and AMR determinants from the Comprehensive Antibiotic Resistance Database (CARD), and regions of similarity between the genomes are also displayed. GI predictions are performed using Sigi-HMM and IslandPath-DIMOB, the two most precise GI prediction tools based on nucleotide composition biases, as well as a novel blast-based consistency step to improve cross-genome prediction consistency. GIs across genomes sharing sequence similarity are grouped into clusters, further aiding comparative analysis and visualization of acquisition and loss of mobile GIs in specific sub-clades. IslandCompare is an open-source software that is containerized for local use, plus available via a user-friendly, web-based interface to allow direct use by bioinformaticians, biologists and clinicians (at https://islandcompare.ca).

Use of social media and college student organizations to increase support for organ donation and advocacy: a case report.

This report focuses on the University of Wisconsin Hospital and Clinics organ procurement organization's efforts to increase deceased organ and tissue donation by using social media and personalized messages targeting members of university student organizations, their families, and their friends. A grant from the US Department of Health and Human Services funded a 2-year study to (1) identify barriers/opportunities for increasing awareness, attitudes, and behaviors related to organ and tissue donation; (2) implement an intervention using social media and personalized message to increase knowledge, support, and donor registrations; (3) measure impact on awareness and attitudinal and behavioral changes within the organization; and (4) assess behavioral measures across a host of social media analytics and organ donor registrations. The results show increases in knowledge about and support for organ donation, including a 20% increase in donor registration. As a result, funding was secured to continue the project for an additional 2 years.

A sequential decision framework for increasing college students' support for organ donation and organ donor registration.

CONTEXT: Despite the fact that college students support social causes, this age group has underparticipated in organ donor registration. Little research attention has been given to understanding deeper, higher-order relationships between the antecedent attitudes toward and perceptions of organ donation and registration behavior. OBJECTIVE: To test a process model useful for understanding the sequential ordering of information necessary for moving college students along a hierarchical decision-making continuum from awareness to support to organ donor registration. DESIGN AND SETTING: The University of Wisconsin organ procurement organization collaborated with the Collegiate American Marketing Association on a 2-year grant funded by the US Health Resources and Services Administration. A total of 981 association members responded to an online questionnaire. MEASURES: The 5 antecedent measures were awareness of organ donation, need acknowledgment, benefits of organ donation, social support, and concerns about organ donation. The 2 consequence variables were support for organ donation and organ donation registration. RESULTS: Structural equation modeling indicated that 5 of 10 direct antecedent pathways led significantly into organ donation support and registration. The impact of the nonsignificant variables was captured via indirect effects through other decision variables. Model fit statistics were good: the goodness of fit index was .998, the adjusted goodness of fit index was .992, and the root mean square error of approximation was .001. IMPLICATIONS: This sequential decision-making model provides insight into the need to enhance the acceptance of organ donation and organ donor registration through a series of communications to move people from awareness to behavior.

A large-scale qualitative study of the potential use of social media by university students to increase awareness and support for organ donation.

OBJECTIVE: A 2-year study funded by the United States Department of Health and Human Services, Health Resources and Services Administration was conducted to identify a conceptual model of how college students, particularly those in student organizations, can be the social media catalyst for viral communications designed to motivate others to learn about the need of organ donation and become organ donors. This study reports the qualitative findings. DESIGN AND DATA COLLECTION: Methods used included an advisory committee, key informant interviews, and focus groups. A total of 317 individuals participated, including 246 students, 19 student organization advisors, 27 organ transplant experts, 20 university health care professionals, and 5 social media experts. ANALYTICAL METHODS: SPSS Text Smart content analysis software was used to code respondents' verbal comments into various categories. The analysis results in groupings of words that represent the main discussion topics. RESULTS: College students understand the need for organ donation and they want to make a difference. The donation community needs to overcome several barriers to motivate college students to become organ donors and donor advocates, including (1) lack of a personal connection with donation, (2) lack of (factual) knowledge about organ donation and how to sign up, (3) common myths and misconceptions, and (4) students have a short-term perspective on life. CONCLUSION AND IMPLICATIONS: Our findings suggest that the donation community can motivate college students to register as organ donors and become advocates through outreach efforts that use social media, student organizations, and other college-based media.

Assessing the learning needs of South Carolina nurses by exploring their perceived knowledge of emergency preparedness: evaluation of a tool.

BACKGROUND: This study assessed South Carolina nurses' perceived knowledge of emergency preparedness to gain a better understanding of their learning needs and to prioritize continuing education and training efforts based on these needs. METHODS: Boone's programming model concept of planning provided the framework for this study, which used a descriptive correlational design and the Emergency Preparedness Information Questionnaire (EPIQ). Data from 207 eligible survey participants were analyzed. RESULTS: Nurses showed an overall low level of self-reported knowledge of emergency preparedness. Nurses reported being most familiar with triage and least familiar with clinical decision making in epidemiology and biological agents. CONCLUSION: By prioritizing learning needs based on a needs assessment and accommodating learning preferences, a systematic and planned approach to educating nurses about this extremely important topic can be implemented to significantly strengthen nurses' ability to respond to disaster events competently and effectively.

Evaluation of an instrument to measure nurses' familiarity with emergency preparedness.

UNLABELLED: The events of September 11, 2001, and the 2005 devastation of Hurricane Katrina have emphasized the importance of educating all nurses in emergency preparedness and bioterrorism. METHODS: Further evaluation (secondary data analysis) of the Emergency Preparedness Information Questionnaire (EPIQ) was conducted, to assess nurses familiarity with emergency preparedness. RESULTS: This study confirmed that the EPIQ, as revised, has sound psychometric characteristics (construct validity and internal reliability) as a tool to measure nurses' self-reported level of familiarity with emergency preparedness. CONCLUSIONS: Additional studies using the revised EPIQ should provide data to assist civilian and military nurse educators and to facilitate the development of competency-based, relevant, emergency preparedness curricula.

Internal marketing and the antecedents of nurse satisfaction and loyalty.

Employee satisfaction and retention are critical issues that influence the success of any organization. Yet, one of the most critical problems facing the worldwide health care industry is the shortage of qualified nurses. Recent calls have been made within the traditional nursing literature for research that utilizes marketing and business models to better understand nurse satisfaction and retention. The purpose of this study is to develop scales that can be used to empirically test a model of the proposed antecedents of nurse job satisfaction and loyalty which have been used widely in the internal marketing and the relationship-marketing literature. Specifically, the study will investigate the degree to which structural bonding, social bonding, financial bonding activities, and quality of care impact how well nurses are satisfied with their job and their commitment to the organization. The results show that quality of care most impacted nurse satisfaction and loyalty, followed by structural, social, and financial bonds.

Understanding the antecedents to recruiting foster care and adoptive parents: a comparison of white and African-American families.

In response to the "chronic shortage" of caregiving families, social marketing campaigns recruiting parents for foster care and special needs adoption are becoming increasingly important for child welfare agencies. This study attempts to fill the void in the understanding of the antecedents that impact the decision to enroll in programs designed to help children in need. The findings from a large-scale study show that knowledge of the process and select motives positively impact involvement likelihood. In contrast, psychological barriers, concern about the enrolment process, negative perceptions of children in need, and fear are detriments to consideration likelihood. African-American families were found to be more receptive and had fewer psychological concerns surrounding the decision process.

Understanding the antecedents of the acceptance of donation after cardiac death by healthcare professionals.

OBJECTIVE: A 3-yr study funded by the U.S. Department of Health and Human Services was conducted to identify potential barriers to and opportunities for increasing the number hospitals with donation after cardiac death (DCD) protocols, the support of DCD by individuals involved in the donation request process, and the number DCD donors recovered. This study reports the qualitative findings. DESIGN: Methods used included an advisory committee and an extensive array of key informant interviews and focus groups. SETTING: Hospitals and telephone contact. SUBJECTS: Discussions with nurses, physicians, social service staff, clergy, administrators, and organ procurement organization staff. A total of 216 people participated. INTERVENTIONS: Collection and analysis of information regarding perceptions of DCD, potential barriers and opportunities, and strategies for gaining support. MEASUREMENT AND MAIN RESULTS: Key barriers included a lack of knowledge about DCD, psychological barriers for DCD vs. brain death, concerns about whether death has been reached, saving vs. killing patients, trust in the organ procurement organization, moving from saving patients to being a donation advocate, and concerns with the DCD process. Opportunities included education initiatives, well-trained requesters, a cultural shift, a consistent DCD protocol separating care from recovery, process monitoring, and a strong sense of teamwork. CONCLUSIONS: Our findings provide a better understanding of healthcare professionals' knowledge, attitudes, and behaviors regarding DCD. Understanding these issues is critical to the implementation of strategic plans for DCD programs. One of the biggest barriers to overcome is a lack of knowledge of DCD, which leads to misperceptions, which in turn contribute to negative attitudes and/or discomfort by healthcare professionals. Communication efforts that are able to educate healthcare professionals and eliminate misperceptions will increase support for DCD. Key to future success requires confident and well-trained DCD requesters.

Participant satisfaction with the vocational rehabilitation process: a micro perspective of relationship dimensions.

This article is the last in a series of two that examines participant satisfaction with the vocational rehabilitation (VR) process. Disabled individuals face formidable challenges when entering the workforce. The VR process involves a complex series of interactions and relationships among participants, counselors, training professionals, ancillary service providers, and employers to help participants prepare for and find employment. In the first article, we identified six relationship dimensions that influence overall satisfaction with vocational training services and presented a highly reliable survey instrument. In part two, we look at the items within each dimension and identify those with the greatest impact on participant satisfaction. The findings show that the level of caring or concern demonstrated by the counselor, an element of the interpersonal social bond dimension, has the greatest affect on participant satisfaction with the entire VR process.

Emergency preparedness competencies: assessing nurses' educational needs.

This article reports findings from a research study designed to assess the level of familiarity Wisconsin nurses have regarding their response to large-scale emergency events. The research process identified 8 emergency preparedness dimensions, which were then investigated in the study. Efforts were also undertaken to determine the types of educational offerings and class-scheduling options most preferred by nurses.

Quality improvement in a federally funded community breast and cervical cancer screening program.

Continuous Quality Improvement (CQI) methods offer healthcare organizations valuable tools for improving services to their patients. These tools are also useful in improving the way an organization delivers its services. In this case study, the authors describe the use of quality improvement activities for improving the enrollment and screening for breast and cervical cancer for the Women's Health Connection (WHC). The WHC is operated by the Nevada Department of Human Resources, Health Division, to provide screening for income eligible women between the ages of 40-64. Funding for the WHC was provided by the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). By using Quality Improvement Teams, the WHC was able to restructure the way women were being enrolled in the program in order to increase the number of women screened and to help the program meet CDC performance indicators. This article documents the quality improvement process used in the case study, highlights the areas improved, and demonstrates how quality improvement was useful in improving services provided to women. It also describes staff acceptance of the quality improvement process and its potential future applications.

Relationship marketing and disadvantaged health care segments: using internal marketing to improve the vocational rehabilitation process.

The purpose of vocational rehabilitation (VR) is to provide disabled individuals with the training and support services needed to assimilate into the workforce. This study incorporates concepts developed in the relationship marketing and internal marketing literature to determine the factors that influence overall satisfaction of vocational training services. Results underscore the importance of social and structural bonds that develop among the multiple stakeholders involved in the VR process. Satisfaction is also influenced by the design and equipment used in the facilities and the efficiency of initiating VR services. A highly reliable instrument to measure VR participant satisfaction is presented.

Retaining medical directors in community health centers. The importance of administrative relationships.

Physician retention has become a critical issue for maintaining the success of today's health care organizations. With many external factors--increasing malpractice premiums, lower reimbursement rates, and managed care controls--driving physicians out of the practice, it is imperative to understand how the internal functions of the organization can help maintain satisfaction in the workplace and prevent physicians from leaving (Reece, 2000; Taylor, 2002). This is especially important in Community and Migrant Health Centers (C/MHCs), federally supported health clinics providing care to low-income and uninsured patients in medically underserved communities and neighborhoods. In this study, we examine the medical directors' roles and responsibilities, their relationships with the C/MHC administrators, and whether these impact satisfaction and, ultimately retention in the centers.

Internal marketing, nurse loyalty and relationship marketing: an exploratory study of German nurses.

Nurse loyalty and retention are critical issues facing the healthcare industry. A lack of continuity in the nursing staff compromises the quality of the care, results in significant costs, and leads to patient concerns about the viability of the healthcare facility. Conversely, a motivated and committed nursing staff creates a solid foundation for implementing initiatives for the improvement of healthcare quality. This article employs the "Relationship Marketing Paradigm" as a framework to understand and enhance nurse loyalty through internal marketing efforts. The results indicate that financial, social and structural bonds have significant, albeit different, impacts on nurse loyalty. Managerial implications and future research directions are discussed.

Development of the University of Wisconsin donation After Cardiac Death Evaluation Tool.

BACKGROUND: Donation after cardiac death is a method by which severely neurologically injured patients not fulfilling brain-death criteria can donate organs. OBJECTIVE: To develop an evaluation tool that can be used to predict if a patient is a suitable candidate for donation after cardiac death. METHODS: The University of Wisconsin Donation After Cardiac Death Evaluation Tool assigns numeric values to observable clinical parameters to yield an overall predictive score of suitability for donation after cardiac death. This evaluation tool is typically utilized in a critical care unit to evaluate patients with a severe neurological injury, who do not meet brain-death criteria, and for whom the physician and family have chosen to terminally withdraw life support. Each patient is disconnected from a ventilator and observed for up to 10 minutes. Observations are then scored to yield a prediction of suitability for donation after cardiac death. RESULTS: Using the University of Wisconsin Donation After Cardiac Death Evaluation Tool, we were able to predict suitability for donation after cardiac death 83.7% of the time, within a 60-minute period and 74.4% of the time within a 120-minute period. The actual results using the tool were higher when clinical observations were included in the donation after cardiac death evaluation--an overall accuracy of 88.4%.