1California Pacific Medical Center Research Institute, San Francisco, CA, USA2Cincinnati Children Hospital Medical Center, Cincinnati, OH, USA3Center for Applied Genomics, UMDNJ, Newark, NJ, USACorrespondence: S McAllister or L Soroceanu, California Pacific Medical Center Research Institute, 475 Brannan Street, Suite 220, San Francisco, CA 94107, USA. A sub population of tumor cells with stem like properties, glioma stem cells (GSCs), is specifically endowed to resist or adapt to the standard therapies, leading to therapeutic resistance. Several anticancer agents, collectively termed redox therapeutics, act by increasing intracellular levels of reactive oxygen species (ROS).
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Thus, hospitals had two indicators of staffing ratios: one for all nurse staffing and one for paediatric nurse staffing.We also examined the effects of staffing by utilising a contemporary paediatric staffing benchmark of no more than four patients per nurse based upon the state of California’s mandated minimum nurse staffing ratios.32 This variable was constructed at the hospital level as a dichotomous variable, with a zero indicating that the average hospital paediatric nurse staffing ratio (based on paediatric nurse reports) was greater than four patients per nurse and a one indicating that the average paediatric nurse staffing ratio was less than or equal to four patients per nurse.A readmission was defined as any repeat hospitalisation occurring within 14days or between 15 and 30days of discharge from an index hospitalisation. To account for patient characteristics, we included measures of patient demographics (age, sex, race, payer), a measure of socioeconomic wellbeing for the patient’s home zip code based upon publicly available US census data,33 primary diagnosis, primary procedure type, comorbidities and illness severity (emergent admission, transfer admission, hospitalisation in the previous year). Of hospital characteristics such as teaching intensity, technology level, bed size and type (children’s vs general) were included to account for organisational characteristics that could confound the relationship between staffing levels and readmission.