1,720,996 research outputs found
Efficient estimation of true fixed-effects stochastic frontier models
Full text linkFixed-effects modeling has become the method of choice in several panel data settings, including models for stochastic frontier analysis. A notable instance of stochastic frontier panel data models is the true fixed-effects model, which allows disentangling unit heterogeneity from efficiency evaluations. While such a model is theoretically appealing, its estimation is hampered by incidental parameters. This note proposes a simple and rather general estimation approach where the unit-specific intercepts are integrated out of the likelihood function. We apply the theory of composite group families to the model of interest and demonstrate that the resulting integrated likelihood is a marginal likelihood with desirable inferential properties. The derivation of the result is provided in full, along with some connections with the existing literature and computational details. The method is illustrated for three notable models, given by the normal-half normal model, the heteroscedastic exponential model, and the normal-gamma model. The results of simulation experiments highlight the properties of the methodology
Does missed nursing care influence the use of physical restraint and its duration in acute medical patients? Secondary analysis of a longitudinal study
No full textMissed nursing care and physical restraint have been identified as indicators of patient safety, but no studies to date have explored their relation. To explore the relation between these two phenomena, a secondary analysis of a longitudinal study on 1464 in-hospital patients and 314 registered nurses was performed. The use of physical restraint was assessed at the bedside on a daily basis; missed care was assessed with the MISSCARE survey. Individual, nursing care, and hospital-level variables were measured. A total of 184 (12.6%) patients were restrained for 20.33% of their in-hospital stay. No significant differences emerged in the occurrence of missed care between restrained and unrestrained patients. However, some common antecedents of these two phenomena emerged: in units where there is a lack of personnel, both an increase in missed care and physical restraint duration should be expected. As a consequence, patients are threatened in their right to receive the required care and they are at risk of being restrained. Moreover, a higher skill mix is a preventive factor, which suggests that the increased numbers of registered nurses on the team, may prevent routine forms of physical restraint use by analyzing the physical restraint in place critically and removing them as soon as possible, thus reducing the duration of the restraints
Unfinished Nursing Care Survey: A development and validation study
Full text linkAims: To develop and validate a comprehensive tool based on those established in the field capable of reflecting the broader concept of Unfinished Nursing Care. Background: Different tools have been established in the field of Missed Care, Rationing Care and Tasks Left Undone. However, despite them sharing similar items and all referring to the common concept of Unfinished Nursing Care, no attempts to collapse them in a single tool capable of reflecting current nursing practice, and its increased complexity, have been attempted to date. Methods: A development and validation study was performed in 2017. After developing the instrument starting from the MISSCARE Survey and critically reviewing the other tools available in the field, the Unfinished Nursing Care Survey (UNCS) was subjected to validation. A total of 1977 nurses from 13 acute Italian hospitals were recruited. Acceptability, construct validity (Mokken Scaling, Explorative and Confirmative Factor Analysis), internal consistency, hypothesis testing and criterion validity were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Results: 1,400 (70.8%) nurses participated. The UNCS is composed of part A (=elements of unfinished care) and part B (=reasons for unfinished care) with 21 and 18 items, respectively. The UNCS has showed high acceptability (>90%). Part A has reported a strong scalability (H =.52), thus suggesting a hierarchical structure among the items. The six factors in part B explained a total variance of 64.3% (internal consistency =.806) as confirmed by the Confirmative Factor Analysis. Conclusions: The comprehensive nature of the UNCS can contribute to the establishment of a common reference measure of the phenomenon worldwide although its psychometric properties require future investigation in different cultural contexts, languages and clinical settings. Implications for Nursing Management: Measuring Unfinished Nursing Care provides information on the processes implicated in the development of adverse events before these become visible; moreover, it can increase awareness on nurses' performance and inform appropriate interventions to improve it
Vulvo-perineal reconstruction with a reversesensitive rectus abdominis salvage flap ina multirecurrent anal carcinoma
No full textReconstructive options after vulvectomy is preferably performed using fasciocutaneous
flaps. If the defect is very large, the use of vertical rectus abdominis myocutaneous
(VRAM) flap is recommended.1
We report a case of a patient affected by multirecurrent anal carcinoma, treated by chemotherapy,
radiotherapy and surgery several times, until an extended abdominoperineal resection of Miles was performed. Since other surgical options were no more available, a primary reverse VRAM flap reconstruction was harvested, together with an end-to-end nerve anastomosis between the cutaneous
ramus of the 8th intercostal nerve and the superior branch of the pudendal nerve to achieve
sensibility. Encouraging results, without actual recurrence of the disease, were obtained
Consumer attitudes towards the mountain product label: Implications for mountain development
Full text linkTo protect and promote the originality and authenticity of mountain foodstuffs, the European Union set Regulation No 1151/2012 to create the optional quality term “mountain product”. Our research aimed at exploring the attractiveness of the mountain product label for consumers, considering both attitude towards the label itself and purchase intentions. We propose a model to investigate relationships between four latent constructs — mountain attractiveness, mountain food attractiveness, attitude towards the mountain product label, and purchase intention — which have been tested, thus confirming the statistical relevance of the relationships. All 47 items selected for describing the latent constructs are suitable for this purpose. Ridge and LASSO results also show that 17 items of the first three constructs are relevant in explaining purchase intentions. Some contextual variables, such as age, income, geographical origin of consumers, and knowledge of mountain products and mountains for tourism purposes, can positively influence consumers’ behavior. These findings could support the design of mountain development strategies, in particular marketing actions for both the product and the territory
The Role of School Leadership on Student Achievement: Evidence from Timss2003
Full text linkLeadership, and especially head-teachers� leadership, has been object of study since the late �60s, but the concept of leadership is neither unanimously defined, nor a consensus has been yet reached on its actual role and actual relevance within the school environment. Good leadership can certainly contribute to school improvement by abetting the motivation, participation, and coordination of the teachers; recent studies have widened the range of action of school leadership research to the various organizational levels: school managers, department heads, coordinators, teachers, and distributed leadership that could yield a higher impact on student achievement than what yet showed. This dissertation takes its moves within the strand of research that identifies a significant role of leadership for student achievement and tries to understand whether there are patterns of behavior of head-teachers that yield better results than others with respect to facilitating the student learning process and whether such patterns are consistent or replicable across countries.
To address this question, the study uses the TIMSS2003 and investigates the relationship between head-teacher time allocation and school characteristics, student background, and student achievement in 18 countries. The model used in the empirical analysis is a three level Multilevel Model with random effects (evaluated using the R-Statistics software) that aims at evaluating the interaction effect between a particular school level variable (the time used by the head-teacher in managerial or leadership activities) and the explanatory variables describing school and student characteristics. What the study shows is that head-teacher specialization (either in management or in leadership) has negligible direct effect on student achievement. Most of all, however, head-teacher specialization reduces the impact that family SES has on student achievement. Moreover, by investigating the impact of school management and school leadership on student achievement on a country-by-country level, a parallelism emerges between the institutional characteristics of school systems and the prevalent head-teacher specialization effect, suggesting that head-teachers are professional that do their best to favor the good functioning of their schools by using the tools that the existing regulations give them.JRC.G.9 - Econometrics and statistical support to antifrau
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