Nurse Leader Influence And Nurse-Sensitive Outcomes In Critical Access Hospitals

Introduction: Rural residents of the United States are sicker, are at higher risk of death, and have shorter lifespans than those in metropolitan areas (Singh & Siahpush, 2014). Nurse leaders may have the opportunity to influence improved patient outcomes in rural areas. No exploration of nurse leader influence as it relates to nurse-sensitive outcomes in rural healthcare settings was found in the literature. The purpose of this study was to determine the differences among nurse leader influence and nurse-sensitive outcome scores in critical access hospitals, which are rural in nature, in North Dakota as compared to other states in the United States. Methods: A questionnaire was sent to nursing leaders at 600 critical access hospitals in 20 states in the United States, with results coming from a total of 19 states including North Dakota. The questionnaire included demographics, the Leadership Influence over the Professional Practices Environment Scale (LIPPES), nurse communication data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and nursing transfer compliance data from the Emergency Department Transfer Communication (EDTC) survey. Reliability and validity have been established for these surveys. Results of the questionnaire were analyzed using descriptive statistics and comparison of means. Results: The sample included 28 nurse leaders in North Dakota and 44 nurse leaders from across 18 other states. Demographics showed similarities across the two groups. All categories of nurse leader influence scores in North Dakota were lower than across the other 18 states. Significant differences were found among four nurse leader influence factors of collegial administrative approach, internal strategy and resolve, access to resources, and the overall influence scores. No significant differences were among scores from the Emergency Department Transfer Communication (EDTC) compliance survey nor the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) compliance survey. Conclusions: Critical access hospital nurse leaders in North Dakota reported comparatively lower collegial administrative approach, access to resources, and internal strategy and resolve levels than those in 18 other states. Support mechanisms should be concentrated on those areas for the leaders in North Dakota. Further research should be conducted to understand the potentially different needs of critical access hospital nurse leaders from their counterparts in larger hospital settings

Factors influencing attrition of students in a baccalaureate nursing program

A nursing shortage is looming in Canada (Canadian Nurses Association, 1997, November 4). It is inperative that as many students graduate from nursing school as possible in order to alleviate this problem. This purpose o f this study was to discover the reasons for student attrition in a Canadian Baccalaureate School of Nursing. Tinto’s model o f college student attrition was applied as the conceptual framework. A Nursing Student Attrition Survey was completed by forty student persisters and nineteen student leavers. Comparisons between the two samples revealed significant differences in that older students, students from urban areas, and students whose mothers and fathers had less post-secondary education were more likely to leave the program of study prior to graduation. The same was found true for students with lower level intentions, goal and institutional commitment, and students with more external commitments. Students persisters were found to feel better about their academic performance and felt that they had more positive peer group interactions than did the student leavers

Intrapsychic factors influencing career aspirations in college women

A 300-item questionnaire designed to assess the relationship and relative importance of several factors for women's career aspirations was answered by 169 female college juniors and seniors. Regression analyses showed that women with high career aspirations were satisfied with their lives; confident of their career plans; willing to postpone marriage; nontraditional in their values and behaviors; generally external in orientation, believing that discrimination is responsible for many of women's failures and that organized pressure rather than individual action is necessary to combat this discrimination; certain that women's demands for equality are justified and that most men agree with them; likely to have had a working mother who was perceived as being dissatisfied with her own life; and if planning to marry soon, endorsing dual role compatability. When all variables were considered simultaneously, attitudinal factors were found to best predict career aspirations, while socialization variables were relatively unimportant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45615/1/11199_2004_Article_BF00287286.pd

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Identification of a BRCA2-Specific modifier locus at 6p24 related to breast cancer risk

Common genetic variants contribute to the observed variation in breast cancer risk for BRCA2 mutation carriers; those known to date have all been found through population-based genome-wide association studies (GWAS). To comprehensively identify breast cancer risk modifying loci for BRCA2 mutation carriers, we conducted a deep replication of an ongoing GWAS discovery study. Using the ranked P-values of the breast cancer associations with the imputed genotype of 1.4 M SNPs, 19,029 SNPs were selected and designed for inclusion on a custom Illumina array that included a total of 211,155 SNPs as part of a multi-consortial project. DNA samples from 3,881 breast cancer affected and 4,330 unaffected BRCA2 mutation carriers from 47 studies belonging to the Consortium of Investigators of Modifiers of BRCA1/2 were genotyped and available for analysis. We replicated previously reported breast cancer susceptibility alleles in these BRCA2 mutation carriers and for several regions (including FGFR2, MAP3K1, CDKN2A/B, and PTHLH) identified SNPs that have stronger evidence of association than those previously published. We also identified a novel susceptibility allele at 6p24 that was inversely associated with risk in BRCA2 mutation carriers (rs9348512; per allele HR = 0.85, 95% CI 0.80-0.90, P = 3.9×10−8). This SNP was not associated with breast cancer risk either in the general population or in BRCA1 mutation carriers. The locus lies within a region containing TFAP2A, which encodes a transcriptional activation protein that interacts with several tumor suppressor genes. This report identifies the first breast cancer risk locus specific to a BRCA2 mutation background. This comprehensive update of novel and previously reported breast cancer susceptibility loci contributes to the establishment of a panel of SNPs that modify breast cancer risk in BRCA2 mutation carriers. This panel may have clinical utility for women with BRCA2 mutations weighing options for medical prevention of breast cancer

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

Reputational risk as a logic of organizing in late modernity

Post-print version. Final version published by Sage; available online at http://oss.sagepub.com/This paper argues that it is useful to regard `reputational risk' as a pervasive logic of organizing and organizational attention. First, we suggest that the risk management agenda has expanded from its roots in technical analysis to become a cornerstone of good governance and responsible actorhood. We illustrate this claim in the context of English universities. Second, we suggest that this expansion in the reach and significance of risk management has increased organizational orientations to reputational risk and to more defensively and legalistically framed forms of asset management. Specifically, organizations are responding to the growth of external bodies which evaluate and rank, and thereby generate reputational risk. In the context of universities, we argue that this leads both to specific transformations in organizational practices in response to ranking systems, and also to an increased generalized concern with reputational risk, which is a symptom of late modern insecurity

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p