搜索结果：Critical care nursing clinics of North America

Excessive caregiver workload in hospital nurses has been implicated in poorer patient care and increased worker burnout. Measurement of this workload in the Intensive Care Unit (ICU) is often done using the Nursing Activities Score (NAS), but this is usually recorded manually and sporadically. Previous work has made use of Ambient Intelligence (AmI) by using computer vision to passively derive caregiver-patient interaction times to monitor staff workload. In this letter, we propose using a Multiscale Vision Transformer (MViT) to passively predict the NAS from low-resolution thermal videos recorded in an ICU. 458 videos were obtained from an ICU in Melbourne, Australia and used to train a MViTv2 model using an indirect prediction and a direct prediction method. The indirect method predicted 1 of 8 potentially identifiable NAS activities from the video before inferring the NAS. The direct method predicted the NAS score immediately from the video. The indirect method yielded an average 5-fold accuracy of 57.21%, an area under the receiver operating characteristic curve (ROC AUC) of 0.865, a F1 score of 0.570 and a mean squared error (MSE) of 28.16. The direct method yielded a MSE of 1

Background: Telephone nursing is the first line of contact for many care-seekers and aims at optimizing the performance of the healthcare system by supporting and guiding patients to the correct level of care and reduce the amount of unscheduled visits. Good statistical models that describe the effects of telephone nursing are important in order to study its impact on healthcare resources and evaluate changes in telephone nursing procedures. Objective: To develop a valid model that captures the complex relationships between the nurse's recommendations, the patients' intended actions and the patients' health seeking behavior. Using the model to estimate the effects of telephone nursing on patient behavior, healthcare utilization, and infer potential cost savings. Methods: Bayesian ordinal regression modeling of data from randomly selected patients that received telephone nursing. Inference is based on Markov Chain Monte Carlo methods, model selection using the Watanabe-Akaike Information Criteria, and model validation using posterior predictive checks on standard discrepancy measures. Results and Conclusions: We present a robust Bayesian ordinal regression model that predicts 76% of

Elucidating the statistical properties of extreme meteo-climatic events and capturing the physical processes responsible for their occurrence are key steps for improving our understanding of climate variability and climate change and for better evaluating the associated hazards. It has recently become apparent that large deviation theory is very useful for investigating persistent extreme events, and specifically, for flexibly estimating long return periods and for introducing a notion of dynamical typicality. Using a methodological framework based on large deviation theory and taking advantage of long simulations by a state-of-the-art Earth System Model, we investigate the 2021 North America Heatwave. Indeed, our analysis shows that the 2021 event can be seen as an unlikely but possible manifestation of climate variability, whilst its probability of occurrence is greatly amplified by the ongoing climate change. We also clarify the properties of spatial coherence of the 2021 heatwave and elucidate the role played by the Rocky Mountains in modulating hot, dry, and persistent extreme events in the Western Pacific region of North America.

The City of Toronto Long Term Care Homes & Services (LTCH&S) division is one of the largest providers of long-term care in the Canadian province of Ontario, providing care to 2,640 residents at 10 homes across Toronto. Our collaboration with LTCH&S was initiated to facilitate the increasingly challenging task of scheduling nursing staff and reduce high absenteeism rate observed among the part-time nurses. We developed a spreadsheet-based scheduling tool to automate the generation of schedules and incorporate nurses' preferences for different shifts into the schedules. At the core of the scheduling tool is a hierarchical optimization model that generates a feasible schedule with the highest total preference score while satisfying the maximum possible demand. Feasible schedules had to abide by a set of complex seniority requirements which prioritized more senior nurses when allocating the available shifts. Our scheduling tool was implemented in a 391-bed home in Toronto. The tool allowed nursing managers to generate feasible schedules within a fraction of an hour, in contrast to the status-quo manual approach which could took up to tens of hours. In addition, the schedule

The flexibility level allowed in nursing care delivery and uncertainty in infusion durations are very important factors to be considered during the chemotherapy schedule generation task. The nursing care delivery scheme employed in an outpatient chemotherapy clinic (OCC) determines the strictness of the patient-to-nurse assignment policies, while the estimation of infusion durations affects the trade-off between patient waiting time and nurse overtime. We study the problem of daily scheduling of patients, assignment of patients to nurses and chairs under uncertainty in infusion durations for an OCC that functions according to any of the three commonly used nursing care delivery models representing fully flexible, partially flexible, and inflexible care models, respectively. We develop a two-stage stochastic mixed-integer programming model that is valid for the three care delivery models to minimize expected weighted cost of patient waiting time and nurse overtime. We propose multiple variants of a scenario grouping-based decomposition algorithm to solve the model using data of a major university oncology hospital. The variants of the algorithm differ from each other according to th

Nursing documentation in intensive care units (ICUs) provides essential clinical intelligence but often suffers from inconsistent terminology, informal styles, and lack of standardization, challenges that are particularly critical in heart failure care. This study applies Direct Preference Optimization (DPO) to adapt Mistral-7B, a locally deployable language model, using 8,838 heart failure nursing notes from the MIMIC-III database and 21,210 preference pairs derived from expert-verified GPT outputs, model generations, and original notes. Evaluation across BLEU, ROUGE, BERTScore, Perplexity, and expert qualitative assessments demonstrates that DPO markedly enhances documentation quality. Specifically, BLEU increased by 84% (0.173 to 0.318), BERTScore improved by 7.6% (0.828 to 0.891), and expert ratings rose across accuracy (+14.4 points), completeness (+14.5 points), logical consistency (+14.1 points), readability (+11.1 points), and structural clarity (+6.0 points). These results indicate that DPO can align lightweight clinical language models with expert standards, supporting privacy-preserving, AI-assisted documentation within electronic health record systems to reduce administ

We present observations of near-infrared 2.12 micro-meter molecular hydrogen outflows emerging from 1.1 mm dust continuum clumps in the North America and Pelican Nebula (NAP) complex selected from the Bolocam Galactic Plane Survey (BGPS). Hundreds of individual shocks powered by over 50 outflows from young stars are identified, indicating that the dusty molecular clumps surrounding the NGC 7000 / IC 5070 / W80 HII region are among the most active sites of on-going star formation in the Solar vicinity. A spectacular X-shaped outflow, MHO 3400, emerges from a young star system embedded in a dense clump more than a parsec from the ionization front associated with the Pelican Nebula (IC 5070). Suspected to be a binary, the source drives a pair of outflows with orientations differing by 80 degrees. Each flow exhibits S-shaped symmetry and multiple shocks indicating a pulsed and precessing jet. The `Gulf of Mexico' located south of the North America Nebula (NGC 7000), contains a dense cluster of molecular hydrogen objects (MHOs), Herbig-Haro (HH) objects, and over 300 YSOs, indicating a recent burst of star formation. The largest outflow detected thus far in the North America and Pelican

For patients experiencing cancer, nurse navigation can ease the burden of complex care by enhancing coordination of health services and patient outcomes. However, in under-resourced areas, trained nurse navigators may be limited or non-existent. In the United States, artificial intelligence (AI)-enabled digital health tools are increasingly available and may help address gaps in care coordination; however, most are not designed to specifically support nursing. This perspective piece discusses a human-centered AI framework that integrates empathic and agentic approaches grounded in the American Nurses Association's code of ethics to support nurses in the United States in cancer care navigation. The framework could augment, not replace, human empathy and agency while improving nurse workflow, patient-clinician relationships, and care coordination services in under-resourced areas.

An emergent challenge in geriatric care is improving the quality of care, which requires insight from stakeholders. Qualitative methods offer detailed insights, but they can be biased and have limited generalizability, while quantitative methods may miss nuances. Network-based approaches, such as quantitative ethnography (QE), can bridge this methodological gap. By leveraging the strengths of both methods, QE provides profound insights into need-finding interviews. In this paper, to better understand geriatric care attitudes, we interviewed ten nursing assistants, used QE to analyze the data, and compared their daily activities in real life with training experiences. A two-sample t-test with a large effect size (Cohen's d=1.63) indicated a significant difference between real-life and training activities. The findings suggested incorporating more empathetic training scenarios into the future design of our geriatric care simulation. The results have implications for human-computer interaction and human factors. This is illustrated by presenting an example of using QE to analyze expert interviews with nursing assistants as caregivers to inform subsequent design processes.

Readmission rates in the hospitals are increasingly being used as a benchmark to determine the quality of healthcare delivery to hospitalized patients. Around three-fourths of all hospital re-admissions can be avoided, saving billions of dollars. Many hospitals have now deployed electronic health record (EHR) systems that can be used to study issues that trigger readmission. However, most of the EHRs are high dimen-sional and sparsely populated, and analyzing such data sets is a Big Data challenge. The effect of some of the well-known dimension reduction techniques is minimized due to presence of non-linear variables. We use association mining as a dimension reduction method and the results are used to develop models, using data from an existing nursing EHR system, for predicting risk of re-admission to the hospitals. These models can help in determining effective treatments for patients to minimize the possibility of re-admission, bringing down the cost and increasing the quality of care provided to the patients. Results from the models show significantly accurate predictions of patient re-admission.

We propose a Bayesian, noisy-input, spatial-temporal generalised additive model to examine regional relative sea-level (RSL) changes over time. The model provides probabilistic estimates of component drivers of regional RSL change via the combination of a univariate spline capturing a common regional signal over time, random slopes and intercepts capturing site-specific (local), long-term linear trends and a spatial-temporal spline capturing residual, non-linear, local variations. Proxy and instrumental records of RSL and corresponding measurement errors inform the model and a noisy-input method accounts for proxy temporal uncertainties. Results focus on the decomposition of RSL over the past 3000 years along the Atlantic coast of North America.

The development of a kilometer-scale E3SM Land Model (km-scale ELM) is an integral part of the E3SM project, which seeks to advance energy-related Earth system science research with state-of-the-art modeling and simulation capabilities on exascale computing systems. Through the utilization of high-fidelity data products, such as atmospheric forcing and soil properties, the km-scale ELM plays a critical role in accurately modeling geographical characteristics and extreme weather occurrences. The model is vital for enhancing our comprehension and prediction of climate patterns, as well as their effects on ecosystems and human activities. This study showcases the first set of full-capability, km-scale ELM simulations over various computational domains, including simulations encompassing 21.6 million land gridcells, reflecting approximately 21.5 million square kilometers of North America at a 1 km x 1 km resolution. We present the largest km-scale ELM simulation using up to 100,800 CPU cores across 2,400 nodes. This continental-scale simulation is 300 times larger than any previous studies, and the computational resources used are about 400 times larger than those used in prior efforts

In the area covering the complex of the North America and Pelican nebulae we identified 13 faint stars with J-H and H-Ks color indices which simulate heavily reddened O-type stars. One of these stars is CP05-4 classified as O5 V by Comeron and Pasquali (2005). Combining magnitudes of these stars in the passbands I, J, H, Ks and [8.3] we were able to suspect that two of them are carbon stars and five are late M-type AGB stars. Interstellar extinction in the direction of these stars was estimated from the background red clump giants in the J-H vs. H-Ks diagram and from star counts in the Ks passband. Four or five stars are found to have a considerable probability of being O-type stars, contributing to the ionization of North America and Pelican. If they really are O-type stars, their interstellar extinction A(V) should be from 16 to 35 mag. Two of them seem to be responsible for bright E and J radio rims discovered by Matthews and Goss (1980).

We present and discuss broad band CCD $UBV(I)_C$ photometry and low resolution spectroscopy for stars in the region of the open cluster NGC 6996, located in the North America Nebula. The new data allow us to tightly constrain the basic properties of this object. We revise the cluster size, which in the past has been significantly underestimated. The width of the Main Sequence is mainly interpreted in terms of differential reddening, and indeed the stars' color excess $E_{B-V}$ ranges from 0.43 to 0.65, implying the presence of a significant and evenly distributed dust component. We cross-correlate our optical photometry with near infrared from 2MASS, and by means of spectral classification we are able to build up extinction curves for an handful of bright members. We find that the reddening slope and the total to selective absorption ratio $R_V$ toward NGC 6996 are anomalous. Moreover the reddening corrected colors and magnitudes allow us to derive estimates for the cluster distance and age, which turn out to be $760 \pm 70 pc$ ($V_{0}-M_{V} = 9.4 \pm 0.2$) and $\sim 350$ Myr, respectively. Basing on our results, we suggest that NGC 6996 is located in front of the North America Neb

Nursing notes, an important part of Electronic Health Records (EHRs), track a patient's health during a care episode. Summarizing key information in nursing notes can help clinicians quickly understand patients' conditions. However, existing summarization methods in the clinical setting, especially abstractive methods, have overlooked nursing notes and require reference summaries for training. We introduce QGSumm, a novel query-guided self-supervised domain adaptation approach for abstractive nursing note summarization. The method uses patient-related clinical queries for guidance, and hence does not need reference summaries for training. Through automatic experiments and manual evaluation by an expert clinician, we study our approach and other state-of-the-art Large Language Models (LLMs) for nursing note summarization. Our experiments show: 1) GPT-4 is competitive in maintaining information in the original nursing notes, 2) QGSumm can generate high-quality summaries with a good balance between recall of the original content and hallucination rate lower than other top methods. Ultimately, our work offers a new perspective on conditional text summarization, tailored to clinical app

Acute kidney injury (AKI) in critically ill patients is associated with significant morbidity and mortality. Development of novel methods to identify patients with AKI earlier will allow for testing of novel strategies to prevent or reduce the complications of AKI. We developed data-driven prediction models to estimate the risk of new AKI onset. We generated models from clinical notes within the first 24 hours following intensive care unit (ICU) admission extracted from Medical Information Mart for Intensive Care III (MIMIC-III). From the clinical notes, we generated clinically meaningful word and concept representations and embeddings, respectively. Five supervised learning classifiers and knowledge-guided deep learning architecture were used to construct prediction models. The best configuration yielded a competitive AUC of 0.779. Our work suggests that natural language processing of clinical notes can be applied to assist clinicians in identifying the risk of incident AKI onset in critically ill patients upon admission to the ICU.

We evaluate the performance of various configurations of the Canadian Regional Climate Model (CRCM6-GEM5) in simulating 10-meter wind speeds using data from 27 AmeriFlux stations across North America. The assessment employs a hierarchy of error metrics, ranging from simple mean bias to advanced metrics that account for the dependence of wind speeds on variables such as friction velocity and stability. The results reveal that (i) the value of roughness length (z0) has a large effect on the simulation of wind speeds, (ii) using a lower limit for the Obhukov length instead of a lower limit for the lowest level wind speed seems to deteriorate the simulation of wind speeds under very stable conditions, (iii) the choice of stability function has a small but noticeable impact on the wind speeds, (iv) the turbulent orographic form drag scheme shows improvement over effective roughness length approach.

Latest advances in the field of natural language processing (NLP) enable new use cases for different domains, including the medical sector. In particular, transcription can be used to support automation in the nursing documentation process and give nurses more time to interact with the patients. However, different challenges including (a) data privacy, (b) local languages and dialects, and (c) domain-specific vocabulary need to be addressed. In this case study, we investigate the case of home care nursing documentation in Switzerland. We assessed different transcription tools and models, and conducted several experiments with OpenAI Whisper, involving different variations of German (i.e., dialects, foreign accent) and manually curated example texts by a domain expert of home care nursing. Our results indicate that even the used out-of-the-box model performs sufficiently well to be a good starting point for future research in the field.

Scientists collaborate through intricate networks, which impact the quality and scope of their research. At the same time, funding and institutional arrangements, as well as scientific and political cultures, affect the structure of collaboration networks. Since such arrangements and cultures differ across regions in the world in systematic ways, we surmise that collaboration networks and impact should also differ systematically across regions. To test this, we compare the structure of collaboration networks among prominent researchers in North America and Europe. We find that prominent researchers in Europe establish denser collaboration networks, whereas those in North-America establish more decentralized networks. We also find that the impact of the publications of prominent researchers in North America is significantly higher than for those in Europe, both when they collaborate with other prominent researchers and when they do not. Although Europeans collaborate with other prominent researchers more often, which increases their impact, we also find that repeated collaboration among prominent researchers decreases the synergistic effect of collaborating.