Non-Compete Covenants in NP Employment Agreements

The process of negotiating an employment contract can be extremely complicated. After a successful hiring process, the nurse practitioner is typically given a written employment contract that contains a number of provisions, including scope of practice, duties, benefits, worksites, and the like. Frequently, this contract also contains provisions that restrict the nurse practitioner's ability to compete with the employer when the relationship is terminated. The law refers to such provisions as covenants not to compete or, more generally, restrictive covenants. This article provides a brief overview of covenants not to compete and reviews some of the cases that have arisen in this regard. The article also suggests some strategies a nurse practitioner will want to consider when negotiating such clauses in an employment contract.     

Successful DNA typing of ultrafiltered urines used to detect EPO doping

Endogenous and exogenous erythropoietin (EPO) present in urine can be distinguished according to their isoelectric profiles. This methodology requires urine samples to be concentrated about 200 to 1000 times with manipulations that should remove most of the cells occurring in the original sample. In this study, we tried to obtain DNA profiles from 10 ultrafiltered urines (retentates) in order to evaluate whether a formal genetic identification was technically feasible. No nuclear DNA profiles could be established from retentates, despite 34 PCR-cycles amplifications. Contrastingly, mitochondrial DNA (mtDNA) profiles were obtained for 9 out of the 10 retentates. Apart from some particularities, retentate mtDNA profiles were all distinct and matched mtDNA profiles of corresponding reference samples.     

不同职级军官对初级军官职务胜任特征的评价

目的：本研究在回顾优秀领导心理特点研究献基础上，通过工作分析，探讨不同职级军官对初级军官胜任特征评价的差异和特点．方法：各军兵种、不同职级军官3020名，完成《优秀初级军官心理素质调查表》6040份，有效率92．4％；采用多级语义量词模糊集评估法对40项指标逐条评价。结果：①军、师级军官总体评价趋势接近，营、连、排相对接近，团级介于两之间．②不同职级军官对能力倾向评价的一致性最好，而在敢为、忠诚、威信和社会交往能力等指标上评价的一致性最差．③在各职级军官评价体系中，评价结构有一定的差异，低级军官更看中能力倾向在初级军官任职特征中的评价意义．结论：不同职级军官在初级军官胜任特征的评价上有各自的特点和结构。     

Two media-reported vaccine events in China from 2013 to 2016: Impact on confidence and vaccine utilization

BackgroundChina media reported infant deaths following hepatitis B vaccination in late 2013, leading to temporary suspension of hepatitis B vaccine (HepB Event) until the deaths were shown to be coincidental and the vaccine was of standard, good quality. In 2016, a criminal ring in Shandong province that had been purchasing, improperly storing, and reselling Category 2 vaccines (private-sector) to 60 (of 200,000) clinics for 5 years, was exposed, publicized, and prosecuted, and the potential health and epidemiological impacts were investigated to determine whether revaccination was necessary (Shandong Vaccine Event).MethodsWe assessed parental confidence in vaccines through 9 telephone surveys in 6 and 11 provinces before, during, and after the two events. Provider confidence was assessed through in-person interviews following each event. Vaccine utilization was assessed using Immunization Information Management System data from township clinics.ResultsIn the early stages of each event, approximately 30% of parents indicated vaccine hesitancy and 18% said they would refuse routine immunization. Five and nine months after each event, hesitancy and refusal decreased, but not to pre-event levels. During the Shandong Vaccine Event, 49·1% of parents indicated refusal to use Category 2 vaccines; six months later, the rate was 32·8%. Use of HepB decreased by 21% during the first 2 weeks of the HepB Event and by 12·6% during the first 4 weeks of Shandong Vaccine Event, but returned to baseline in less than 3 months. Use of Category 2 vaccine decreased by 49·5% in the first 3 weeks of the Shandong Vaccine Event and by 28·7% 6 months later. After the Shandong Vaccine Event, 64% of clinicians held high confidence in routine immunization, lower than at baseline.ConclusionsThe two events caused mistrust, loss of confidence, and decreases in use of vaccines by parents and providers. In addition to ensuring immunization program integrity, effective communications and ongoing monitoring of vaccine use and confidence should be included to restore confidence and trust in vaccines.     

In silico designed mRNA vaccines targeting CA-125 neoantigen in breast and ovarian cancer

Somatic mutation-derived neoantigens are associated with patient survival in breast and ovarian cancer. These neoantigens are targets for cancer, as shown by the implementation of neoepitope peptides as cancer vaccines. The success of cost-effective multi-epitope mRNA vaccines against SARS-Cov-2 in the pandemic established a model for reverse vaccinology. In this study, we aimed to develop an in silico pipeline designing an mRNA vaccine of the CA-125 neoantigen against breast and ovarian cancer, respectively. Using immuno-bioinformatics tools, we predicted cytotoxic CD8⁺ T cell epitopes based on somatic mutation-driven neoantigens of CA-125 in breast or ovarian cancer, constructed a self-adjuvant mRNA vaccine with CD40L and MHC-I -targeting domain to enhance cross-presentation of neoepitopes by dendritic cells. With an in silico ImmSim algorithm, we estimated the immune responses post-immunization, showing IFN-γ and CD8⁺ T cell response. The strategy described in this study may be scaled up and implemented to design precision multi-epitope mRNA vaccines by targeting multiple neoantigens.     

Personal risk or societal benefit? Investigating adults’ support for COVID-19 childhood vaccination

Parental hesitancy poses a serious threat to the success of the COVID-19 childhood vaccination campaign. We investigate whether adults' opinions on childhood vaccination can be influenced via two survey experiments in Italy (n = 3,633 participants) and the UK (n = 3,314 participants). Respondents were randomly assigned to: a “risk treatment” that highlighted the potential risks of COVID-19 to a child, a “herd immunity treatment” that emphasized the community benefits of pediatric vaccination, or a control message. Participants’ probability of supporting COVID-19 childhood vaccination was then assessed on a 0–100 scale. We find that the “risk treatment” reduced the proportion of Italian parents strongly against vaccination by up to 29.6 %, while increasing the proportion of neutral parents by up to 45.0 %. The “herd immunity treatment”, instead, was only effective among non-parents, resulting in a lower proportion of individuals against pediatric vaccination and a higher proportion of individuals in favor (both shifted by around 20 %).     

Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations

Ensuring that publicly funded health systems are democratically accountable is an enduring challenge in policy and practice. One strategy for enhancing public officials' accountability is to elect members of the public to oversee their performance. Several countries have experimented with direct elections to healthcare organizations. The most directly comparable examples involve some Canadian regional health authorities, New Zealand district health boards, foundation trusts in England and health boards in Scotland. We propose three aspects of the process by which the democratizing effects of elections should be judged: authorization, accountability and influence. Evidence from these countries suggests that the democratization of health systems is a complex task, which cannot be completed simply by introducing elections. Copyright © 2015 John Wiley & Sons, Ltd.     

Information Systems for Healthcare: Why we haven't had more success: The Top 15 Reasons

Over the last number of years, I have often been asked: “Why haven't we had more success in implementing Information Technology (IT) in Healthcare?” Unfortunately, there is no simple answer to this question. The answer is usually heavily dependent on several factors that “define” the specific implementation in question - consequently, the answer is one comprised of a number of interrelated factors or components. In order to facilitate this answer process, this paper attempts to identify these individual answer components. At the very least, this will help simplify the process of answering future questions by referring to the components outlined herein. At most, in addition to providing a reference compendium for others, it will assist in increasing the solution implementation success rate by exploring the problem definition in detail: The first step in solving a problem is to have it fully articulated.