The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design.

AIMS: To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. DESIGN: Nested diary study. METHODS: Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. RESULTS: Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. CONCLUSION: The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. IMPACT: By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. REPORTING METHOD: The study has adhered to STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Autonomy, self-realization, and psychological empowerment: a prospective mixed methods study of the effects of residential immersive life skills programs for youth with physical disabilities.

PURPOSE: To examine changes in self-determination associated with youth participation in residential immersive life skills (RILS) programs. METHOD: In this prospective mixed methods study, the Arc's Self-Determination Scale was administered pre- and post-program, and at 3- and 12-month follow-ups, to 27 RILS youth and a comparison group of 11 youth enrolled in a non-residential life skills program. Ten RILS youth were interviewed 3 and 12 months post-program, with content analysis used to explore changes in autonomy, self-realization, and psychological empowerment. RESULTS: RILS youth showed statistically significant increases in autonomy immediately after the program, which were maintained one year later, whereas the comparison group displayed increased autonomy only at 3 months post-program. Qualitatively, RILS youth emphasized changes in behavioral autonomy and psychological empowerment 3 months post-program, whereas at one year there was greater emphasis on changes in self-realization. Using a triangulation protocol, the mixed methods data were interpreted as showing agreement regarding changes in autonomy due to intervention, partial agreement regarding self-realization, and dissonance regarding psychological empowerment. CONCLUSIONS: RILS programs can enhance the autonomy of youth with physical disabilities and contribute to their sense of confidence and understanding of themselves as they move forward in life.

The findings suggest the importance of the immersive, away-from-home component of residential immersive life skills programs in enhancing the autonomy of youth with disabilitiesYouth reported changes in their level of autonomy after attending residential immersive life skills programs, as well as feeling more confident in living on their ownResidential immersive life skills programs can contribute to youth's understanding of themselves as they transition to adulthood.

An overview of optimal designs under a given budget in cluster randomized trials with a binary outcome.

Cluster randomized trial design may raise financial concerns because the cost to recruit an additional cluster is much higher than to enroll an additional subject in subject-level randomized trials. Therefore, it is desirable to develop an optimal design. For local optimal designs, optimization means the minimum variance of the estimated treatment effect under the total budget. The local optimal design derived from the variance needs the input of an association parameter ρ in terms of a "working" correlation structure R(ρ) in the generalized estimating equation models. When the range of ρ instead of an exact value is available, the parameter space is defined as the range of ρ and the design space is defined as enrollment feasibility, for example, the number of clusters or cluster size. For any value ρ within the range, the optimal design and relative efficiency for each design in the design space is obtained. Then, for each design in the design space, the minimum relative efficiency within the parameter space is calculated. MaxiMin design is the optimal design that maximizes the minimum relative efficiency among all designs in the design space. Our contributions are threefold. First, for three common measures (risk difference, risk ratio, and odds ratio), we summarize all available local optimal designs and MaxiMin designs utilizing generalized estimating equation models when the group allocation proportion is predetermined for two-level and three-level parallel cluster randomized trials. We then propose the local optimal designs and MaxiMin designs using the same models when the group allocation proportion is undecided. Second, for partially nested designs, we develop the optimal designs for three common measures under the setting of equal number of subjects per cluster and exchangeable working correlation structure in the intervention group. Third, we create three new Statistical Analysis System (SAS) macros and update two existing SAS macros for all the optimal designs. We provide two examples to illustrate our methods.

Sample size considerations for assessing treatment effect heterogeneity in randomized trials with heterogeneous intracluster correlations and variances.

An important consideration in the design and analysis of randomized trials is the need to account for outcome observations being positively correlated within groups or clusters. Two notable types of designs with this consideration are individually randomized group treatment trials and cluster randomized trials. While sample size methods for testing the average treatment effect are available for both types of designs, methods for detecting treatment effect modification are relatively limited. In this article, we present new sample size formulas for testing treatment effect modification based on either a univariate or multivariate effect modifier in both individually randomized group treatment and cluster randomized trials with a continuous outcome but any types of effect modifier, while accounting for differences across study arms in the outcome variance, outcome intracluster correlation coefficient (ICC) and the cluster size. We consider cases where the effect modifier can be measured at either the individual level or cluster level, and with a univariate effect modifier, our closed-form sample size expressions provide insights into the optimal allocation of groups or clusters to maximize design efficiency. Overall, our results show that the required sample size for testing treatment effect heterogeneity with an individual-level effect modifier can be affected by unequal ICCs and variances between arms, and accounting for such between-arm heterogeneity can lead to more accurate sample size determination. We use simulations to validate our sample size formulas and illustrate their application in the context of two real trials: an individually randomized group treatment trial (the AWARE study) and a cluster randomized trial (the K-DPP study).

Partition of variation for predicting experimental power with a broiler chicken example.

A 1932 editorial in Poultry Science stated that sampling theory, or experimental power, could be useful for "the investigator to know how many … birds to put into each experimental pen." Nevertheless, in the past 90 yr, appropriate experimental power estimates have rarely been applied to research with poultry. To estimate the overall variation and appropriate use of resources with animals in pens, a nested analysis should be conducted. Bird-to-bird and separate pen-to-pen variances were separated for 2 datasets, one from Australia and one from North America. The implications of using variances for birds per pen and pens per treatments are detailed. With 5 pens per treatment, increasing birds per pen from 2 to 4 decreased the SD from 183 to 154, but increasing birds/pen from 100 to 200 only decreased the SD from 70 to 60. With 15 birds per treatment, increasing pens/treatment from 2 to 3 decreased SD from 140 to 126, but increasing pens/treatment from 11 to 12 only decreased the SD from 91 to 89. Choosing the number of birds to include in any study should be based on expectations from historical data and the amount of risk investigators are prepared to accept. Too little replication will not allow relatively small differences to be detected. On the other hand, too much replication is wasteful in terms of birds and resources, and violates the fundamental principles of the ethical use of animals in research. Two general conclusions can be made from this analysis. First, it is very difficult to detect 1% to 3% differences in broiler chicken body weight with only one experiment consistently because of inherent genetic variability. Second, increasing either birds per pen or pens per treatment decreased the SD in a diminishing returns fashion. The example presented here is body weight, of primary importance to production agriculture, but it is applicable whenever a nested design is used (multiple samples from the same bird or tissue, etc.).

Models for cluster randomized designs using ranked set sampling.

Cluster randomized designs (CRD) provide a rigorous development for randomization principles for studies where treatments are allocated to cluster units rather than the individual subjects within clusters. It is known that CRDs are less efficient than completely randomized designs since the randomization of treatment allocation is applied to the cluster units. To mitigate this problem, we embed a ranked set sampling design from survey sampling studies into CRD for the selection of both cluster and subsampling units. We show that ranking groups in ranked set sampling act like a covariate, reduce the expected mean squared cluster error, and increase the precision of the sampling design. We provide an optimality result to determine the sample sizes at cluster and sub-sample level. We apply the proposed sampling design to a dental study on human tooth size, and to a longitudinal study from an education intervention program.

Phenolic profiling and antioxidant evaluation of extracts from Southern African indigenous fruits byproducts.

The call to build climate-resilient food systems in Africa has revived interest in indigenous fruits, which, however, remain under-researched. In this study, the phenolic content and antioxidant profiles of seed and pulp of ethanolic extracts from eight Southern African indigenous fruits were evaluated using UPLC-ESI-Q-TOF/MS and four antioxidant assays. Total phenols and hydroxycinnamic acids were highest in Dovyalis caffra (Kei apple) seed (5084.5 and 3403.83 mg/kg). Flavonoids were most abundant in Colpoon compressum (Colpoon) seed (1127.23 mg/kg), while hydrolysable tannins were highest in Syzygium guineense (Water pear) seed (666.13 mg/kg). Proanthocyanidins were abundant in Harpephyllum caffrum (Wild plum) pulp while anthocyanins were highest in Olea africana (Wild olive) pulp. Hierarchical clustering heatmap analysis showed similar concentration and diversity in the composition of reported compounds. Syzygium guineense seed had the lowest DPPH values. ORAC values were highest in O. africana pulp while H. caffrum pulp had the highest FRAP values and lipoxygenase inhibition capacity. In conclusion, the study revealed a diverse profile of phenolics in indigenous fruits extracts, to which their bioactivity is attributed. Specifically, H. caffrum pulp and S. guineense seed have potential as natural sources of phenolic antioxidants for food application.

Engagement in migrant organizations for immigrant integration: A mixed-method study with Peruvians in Chile.

Immigrant communities in Chile face barriers to their integration, in the form of discrimination and social exclusion. Psychology of liberation claims that, when minority groups experience oppressing conditions, community engagement can be a path toward integration. Nevertheless, community participation has been mainly studied in North America and Europe. Through a concurrent nested mixed-method design, this study explores the relation between community engagement and perception of integration of Peruvian immigrants in Santiago de Chile. One hundred and ten Peruvians (age range 19 to 52 years), engaged in migrant organizations (MOs), completed a self-report questionnaire that aims to identify the predictors of integration based on psychosocial perspective (education), acculturation (national identity and ethnic identity), and liberation psychology literature (perceived institutional sensitivity, knowledge of the Chilean culture and laws). Additionally, 18 Peruvian leaders (ages 31 to 56 years) were interviewed in order to explore intergroup relations and organizational strategies that their MOs use to enhance integration. An interesting and novel finding points to the role of a Latin-American identity that appears to have potential negative consequences in maintaining the status quo for the social exclusion that Peruvians currently face.

Investigation of mechanical behaviors and improved design of V-shaped braid stents.

V-shaped braid stents (VBSs), as highly retrievable and flexible nitinol stents, are extensively applied in endovascular diseases. They also cause less damage to vessel wall compared to tube-cutting stents. However, poor performance of VBS or suboptimal operation can give rise to unwanted clinical situations such as thrombosis and intimal hyperplasia. Therefore, research on designing factors affecting the performance of these devices is of great significance. Furthermore, simulation of stenting process can help designers understand the interactions of stents and vessel wall to reduce time to market. Thus, finite element analysis (FEA) and bench test are performed taking into account both designing factors and stenting process of VBS, including development of parametric modeling tool, research on the relationships among structural parameters and radial force, exploration of the interactions of VBS and vessel wall and pulsating load effect. This research was performed using a commercial solver Abaqus/standard with a user material subroutine (UMAT/nitinol). Structural parameters of VBS, unit-cell height and wire diameter have significant impacts on radial force, unit-cell number has slight influence on radial force, and arc diameter has almost negligible impact on radial force. Without pulsatile load, maximum stress and strain always occur in arc position; however, in pulsatile load, maximum stress and strain are gradually transformed to strut position. The stress created near vessel wall and VBS interface is higher than interaction stress due to pulsating load. The obtained result provided valuable information on the structural design of stents as well as the effects of stent on vessel wall and that vessel wall on stent deformation.Graphical abstract[Formula: see text].

How to use analysis of variance correctly——an analysis of variance for the univariate quantitative data collected from the nested design / 四川精神卫生

The purpose of this paper was to introduce the nested design and its quantitative data analysis of variance and the SAS implementation. If one of the following two characteristics existed in a specific experimental study， a nested design could be considered to arrange the experiment. Firstly， there was a nested relationship between factors in natural attributes. Secondly， with professional knowledge as the basis， the impact of each factor on the quantitative observation results was divided into primary and secondary. The first feature mentioned above meant that the factors related to the subjects had the conditions for grouping and regrouping. The second feature mentioned above meant that the status of each factor was unequal. In the variance analysis of quantitative data， the calculation formulas of variable error mean square was required to use. Based on four examples and with the help of the SAS software， this paper implemented the univariate analysis of variance for the quantitative data of the nested design， and gave the detailed explanations for the output results of SAS software.

Supplementing electronic health records through sample collection and patient diaries: A study set within a primary care research database.

PURPOSE: To describe a novel observational study that supplemented primary care electronic health record (EHR) data with sample collection and patient diaries. METHODS: The study was set in primary care in England. A list of 3974 potentially eligible patients was compiled using data from the Clinical Practice Research Datalink. Interested general practices opted into the study then confirmed patient suitability and sent out postal invitations. Participants completed a drug-use diary and provided saliva samples to the research team to combine with EHR data. RESULTS: Of 252 practices contacted to participate, 66 (26%) mailed invitations to patients. Of the 3974 potentially eligible patients, 859 (22%) were at participating practices, and 526 (13%) were sent invitations. Of those invited, 117 (22%) consented to participate of whom 86 (74%) completed the study. CONCLUSIONS: We have confirmed the feasibility of supplementing EHR with data collected directly from patients. Although the present study successfully collected essential data from patients, it also underlined the requirement for improved engagement with both patients and general practitioners to support similar studies.

A validated fast difference spectrophotometric method for 5-hydroxymethyl-2-furfural (HMF) determination in corn syrups.

Corn syrups, important ingredients used in food and beverage industries, often contain high levels of 5-hydroxymethyl-2-furfural (HMF), a toxic contaminant. In this work, an in house validation of a difference spectrophotometric method for HMF analysis in corn syrups was developed using sophisticated statistical tools by the first time. The methodology showed excellent analytical performance with good selectivity, linearity (R2=99.9%, r>0.99), accuracy and low limits (LOD=0.10mgL-1 and LOQ=0.34mgL-1). An excellent precision was confirmed by repeatability (RSD (%)=0.30) and intermediate precision (RSD (%)=0.36) estimates and by Horrat value (0.07). A detailed study of method precision using a nested design demonstrated that variation sources such as instruments, operators and time did not interfere in the variability of results within laboratory and consequently in its intermediate precision. The developed method is environmentally friendly, fast, cheap and easy to implement resulting in an attractive alternative for corn syrups quality control in industries and official laboratories.

Using InVivoStat to perform the statistical analysis of experiments.

The need to improve reproducibility and reliability of animal experiments has led some journals to increase the stringency of the criteria that must be satisfied before manuscripts can be considered suitable for publication. In this article we give advice on experimental design, including minimum group sizes, calculating statistical power and avoiding pseudo-replication, which can improve reproducibility. We also give advice on normalisation, transformations, the gateway analysis of variance strategy and the use of p-values and confidence intervals. Applying all these statistical procedures correctly will strengthen the validity of the conclusions. We discuss how InVivoStat, a free-to-use statistical software package, which was designed for life scientists, especially animal researchers, can be used to help with these principles.

Consistent patterns of variation in macrobenthic assemblages and environmental variables over multiple spatial scales using taxonomic and functional approaches.

Spatial variability of environmental factors and macrobenthos, using species and functional groups, was examined over the same scales (100s of cm to >100 km) in intertidal sediments of two transitional water systems. The objectives were to test if functional groups were a good species surrogate and explore the relationship between environmental variables and macrobenthos. Environmental variables, diversity and the multivariate assemblage structure showed the highest variability at the scale of 10s of km. However, abundance was more variable at 10s of m. Consistent patterns were achieved using species and functional groups therefore, these may be a good species surrogate. Total carbon, salinity and silt/clay were the strongest correlated with macrobenthic assemblages. Results are valuable for design and interpretation of future monitoring programs including detection of anthropogenic disturbances in transitional systems and propose improvements in environmental variable sampling to refine the assessment of their relationship with biological data across spatial scales.

Within leaf variation is the largest source of variation in agroinfiltration of Nicotiana benthamiana.

BACKGROUND: Transient gene expression utilizing syringe agroinfiltration offers a simple and efficient technique for different transgenic applications. Leaves of Nicotiana benthamiana show reliable and high transformation efficiency, but in quantitative assays also a certain degree of variation. We used a nested design in our agroinfiltration experiments to dissect the sources of this variation. RESULTS: An intron containing firefly luciferase gene was used as a reporter for agroinfiltration. A number of 6 week old tobacco plants were infiltrated for their top leaves, several samples were punched from the leaves after 2 days of transient expression, and protein extracts from the samples were repeatedly measured for luciferase activity. Interestingly, most of the variation was due to differences between the sampling spots in the leaves, the next important source being the different leaves on each plant. Variation between similar experiments, between plants and between repetitive measurements of the extracts could be easily minimized. CONCLUSIONS: Efforts and expenditure of agroinfiltration experiments can be optimized when sources of variation are known. In summary, infiltrate more plants but less leaves, sample more positions on the leaf but run only few technical replicates.

Efficient treatment allocation in two-way nested designs.

Cluster randomized and multicenter trials sometimes combine two treatments A and B in a factorial design, with conditions such as A, B, A and B, or none. This results in a two-way nested design. The usual issue of sample size and power now arises for various clinically relevant contrast hypotheses. Assuming a fixed total sample size at each level (number of clusters or centers, number of patients), we derive the optimal proportion of the total sample to be allocated to each treatment arm. We consider treatment assignment first at the highest level (cluster randomized trial) and then at the lowest level (multicenter trial). We derive the optimal allocation ratio for various sets of clinically relevant hypotheses. We then evaluate the efficiency of each allocation and show that the popular balanced design is optimal or highly efficient for a range of research questions except for contrasting one treatment arm with all other treatment arms. We finally present simple equations for the total sample size needed to test each effect of interest in a balanced design, as a function of effect size, power and type I error α. All results are illustrated on a cluster-randomized trial on smoking prevention in primary schools and on a multicenter trial on lifestyle improvement in general practices.

Analysis of biological and technical variability in gene expression assays from formalin-fixed paraffin-embedded classical Hodgkin lymphomas.

Formalin-fixed paraffin-embedded (FFPE) tissues are invaluable sources of biological material for research and diagnostic purposes. In this study, we aimed to identify biological and technical variability in RT-qPCR TaqMan® assays performed with FFPE-RNA from lymph nodes of classical Hodgkin lymphoma samples. An ANOVA-nested 6-level design was employed to evaluate BCL2, CASP3, IRF4, LYZ and STAT1 gene expression. The most variable genes were CASP3 (low expression) and LYZ (high expression). Total variability decreased after normalization for all genes, except by LYZ. Genes with moderate and low expression were identified and suffered more the effects of the technical manipulation than high-expression genes. Pre-amplification was shown to introduce significant technical variability, which was partially alleviated by lowering to a half the amount of input RNA. Ct and Cy0 quantification methods, based on cycle-threshold and the kinetic of amplification curves, respectively, were compared. Cy0 method resulted in higher quantification values, leading to the decrease of total variability in CASP3 and LYZ genes. The mean individual noise was 0.45 (0.31 to 0.61 SD), indicating a variation of gene expression over ~1.5 folds from one case to another. We showed that total variability in RT-qPCR from FFPE-RNA is not higher than that reported for fresh complex tissues, and identified gene-, and expression level-sources of biological and technical variability, which can allow better strategies for designing RT-qPCR assays from highly degraded and inhibited samples.

Genetic parameter estimates in yellow passion fruit based on design I

The aim of this work was to study the genetic parameters, to obtaine the progenies by crossings among the yellow passion fruits cultivars (Passiflora edulis f. flavicarpa), following the Design I. The results of the variance analysis demonstrated large variability to be exploited in the population. The trait number of fruit per plant presented the largest additive genetic variation coefficient, demonstrating that larger gains could be obtained for the trait. In terms of genetic action, number of fruits per plant, skin thickness and number of days by flowering have demonstrated to be characterized by the overdominance. Other important traits seem to have presented larger addictive effect than the dominance, as weight, length and width of fruits. The highest values of the coefficients of heritabilities were obtained for the males and the smallest for the females within males, and for the selection the coefficients should be used in the narrow sense.

Com o objetivo de se estimarem parâmetros genéticos, procedeu-se a obtenção de progênies por cruzamentos entre cultivares de maracujá amarelo (Passiflora edulis f. flavicarpa) seguindo o Delineamento I. Os resultados da análise de variância demonstraram existir grande variabilidade a ser explorada na população. Número médio de frutos expressou o maior coeficiente de variação genético aditivo, demonstrando que maiores ganhos podem ser obtidos para o caráter. Em termos de ação gênica, número de frutos por planta, espessura de casca e número de dias para o florescimento demonstraram ser caracterizadas por efeito sobredominante dos genes. Outras características importantes apresentaram efeito aditivo maior do que o dominante, como ocorreu com peso, comprimento e largura de frutos. Os valores dos coeficientes de herdabilidade mais elevados foram obtidos para famílias de machos e os menores para famílias de fêmeas dentro de machos, sendo que para fins de seleção devem ser utilizados os coeficientes no sentido restrito.