Advanced practice nursing role development: factor analysis of a modified role delineation tool

Aim his study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third paper from a multi-phase Australian study aimed at assigning advanced practice roles. Methods A postal survey was conducted of a random sample of state government employed Registered nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbach’s alpha coefficient determined reliability of the overall scale and identified factors. Results There were 658 responses (42% response rate). The five factors found with loadings of ≥.400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbach’s alpha coefficient was .94 overall and for the factors ranged from 0.83 to 0.95. Conclusion Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment

Protease production and in vitro growth of Sarracenia purpurea

Prey digestion in the insectivorous plant Sarracenia purpuero was investigated with consideration of three sources of proteolytic enzymes self-digestion by the prey, bacteria in the plant pitcher, and enzymes produced by the plant itself. To do this, 5. purpurea seedlings were grown under sterile conditions and tissue cultures were established. The plant seedlings and tissue culture grew slowly. Tests on pitcher fluid in plant pitchers, or artificial pitchers containing water, or pitcher fluid, and with or without a cricket as prey showed that the cricket is a very important source of protease and that without induction of proteolytic activity by captured prey, the pitcher is largely inactive. More research is needed to determine the relative importance of the different sources of protease in the 5. purpurea plant pitcher, particularly pitcher plants grown in sterile conditions will greatly advance this research by permitting investigation of the contribution of the plant pitcher alone

Relationality in an Age of Measurable Outcomes: Teaching, Tenure, and Collegiality.

Ph.D. Thesis. University of Hawaiʻi at Mānoa 2017

Computing normalisers of intransitive groups

Funding: The first and third authors would like to thank the Isaac Newton Institute for Mathematical Sciences, Cambridge, for support and hospitality during the programme “Groups, Representations and Applications: New perspectives”, where work on this paper was undertaken. This work was supported by EPSRC grant no EP/R014604/1. This work was also partially supported by a grant from the Simons Foundation. The first and second authors are supported by the Royal Society (RGF\EA\181005 and URF\R\180015).The normaliser problem takes as input subgroups G and H of the symmetric group Sn, and asks one to compute NG(H). The fastest known algorithm for this problem is simply exponential, whilst more efficient algorithms are known for restricted classes of groups. In this paper, we will focus on groups with many orbits. We give a new algorithm for the normaliser problem for these groups that performs many orders of magnitude faster than previous implementations in GAP. We also prove that the normaliser problem for the special case G=Sn  is at least as hard as computing the group of monomial automorphisms of a linear code over any field of fixed prime order.Publisher PDFPeer reviewe

A Phenomenological Study of the Experiences of Master’s Level Students of Color in Counseling Programs

This qualitative study investigated the training experiences of 12 students of color in CACREP-accredited master’s level counseling programs using semi-structured phenomenological interviews. The 12 participants identified as Asian American (n = 2), Japanese American (n = 1), Chinese (n = 1), Black (n = 1), African American (n = 1), Latino and/or Hispanic (n = 3), and multiracial (n = 3). We used interpretive phenomenological analysis and identified three main themes: cultural marginalization; biculturalism; and safe or counter-hegemonic relationships. Training implications for counselor education programs are provided

Emergency department diagnosis of upper extremity deep venous thrombosis using bedside ultrasonography

A 27-year-old man presents to the emergency department with a 1-day history of severe right upper extremity pain and swelling. The patient's status is post open reduction internal fixation for a left tibial plateau fracture, which was complicated by methicillin-sensitive Staphylococcus aureus osteomyelitis. A peripherally inserted central catheter (PICC) line was subsequently placed for intravenous antibiotic therapy. Emergency department bedside ultrasound examination of both the right axillary vein and subclavian vein near the PICC line tip revealed deep venous thrombosis of both veins. Bedside upper extremity vascular ultrasonography can assist in the rapid diagnosis of upper extremity deep venous thrombosis in the emergency department

Vasculitis manifested with multiple mass lesions in kidneys, lungs and soft tissue, mimicking malignant tumors

We report a case of granulomatosis with polyangiitis (GPA) (Wegner's granulomatosis) who presented with multiple mass lesions in kidneys and lung lobes, as well as neck soft tissue, mimicking malignancies. This 71-year-old woman initially presented with sudden right foot drop, left calf pain and right eye vision loss. She was treated with corticosteroid for the diagnosis of possible temporal arteritis. Months after steroid was tapered to 2 mg per day, she developed increasing fatigue, weight loss, and shortness of breath. CT scan showed lung mass lesions in left upper lobe (3.8 × 2.4 cm), right mid lung with pleural extension (3.4 × 3.3 cm), and right lower lobe (1.1 × 1.0 cm); right neck (3.3 × 2.6 cm), right kidney (2.3 × 1.8 cm) and left kidney (2.0 × 1.6 cm). Right quadriceps muscle biopsy shows focal granulomatous inflammation. Lung biopsy showed necrotizing and poorly formed granulomatous inflammation. Biopsies of kidney mass lesions showed necrotizing and non-necrotizing granulomatous inflammation. No crescentic or necrotizing glomerular lesions were observed in the total 40 sampled glomeruli. No malignancy was identified in any of the biopsies. Her c-ANCA was found to be positive and PR3-ANCA antibody was 6.88 U/ml (normal 0–0.90 U/ml). She was diagnosed with granulomatosis with polyangiitis and treated with high dose corticosteroid and rituximab. Eight months later, follow-up showed resolved mass lesions by chest X-ray and CT and stable renal function. The case highlights the atypical clinical presentation of vasculitis and the significance of considering this possibility in differential diagnosis when confronting mass lesions present in multiple organ systems. Biopsy is critical for the correct diagnosis to initiate timely and appropriate treatment, and also important to avoid unnecessary surgical resection

Accuracy of ICD-9-CM Codes by Hospital Characteristics and Stroke Severity: Paul Coverdell National Acute Stroke Program

Background—Epidemiological and health services research often use International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes to identify patients with clinical conditions in administrative databases. We determined whether there are systematic variations between stroke patient clinical diagnoses and ICD‐9‐CM codes, stratified by hospital characteristics and stroke severity. Methods and Results—We used the records of patients discharged from hospitals participating in the Paul Coverdell National Acute Stroke Program in 2013. Within this stroke‐enriched cohort, we compared agreement between the attending physician\u27s clinical diagnosis and principal ICD‐9‐CM code and determined whether disagreements varied by hospital characteristics (presence of a stroke unit, stroke team, number of hospital beds, and hospital location). For patients with a documented National Institutes of Health Stroke Scale score at admission, we assessed whether diagnostic agreement varied by stroke severity. Agreement was generally high (\u3e 89%); differences between the physician diagnosis and ICD‐9‐CM codes were primarily attributed to discordance between ischemic stroke and transient ischemic attack (TIA), and subarachnoid and intracerebral hemorrhage. Agreement was higher for patients in metropolitan hospitals with stroke units, stroke teams, and \u3e 200 beds (all P \u3c 0.001). Agreement was lowest (60.3%) for rural hospitals with ≤ 200 beds and without stroke units or teams. Agreement was also lower for milder (94.9%) versus more‐severe (96.4%) ischemic strokes (P \u3c 0.001). Conclusions—We identified disagreements in stroke/TIA coding by hospital characteristics and stroke severity, particularly for milder ischemic strokes. Such systematic variations in ICD‐9‐CM coding practices can affect stroke case identification in epidemiological studies and may have implications for hospital‐level quality metric