Evaluating the Impact of an Evidence Based Practice Education Program in a Nurse Residency Program on Evidence Based Practice Beliefs, Implementation and Competency

For organizations to ensure that they are providing safe and quality patient care, they must promote a culture of care based on Evidence Based Practice (EBP). To improve healthcare quality nurses must make care decisions based on the most current scientific evidence. In fact the Institute of Medicine set a goal that 90% of clinical decisions be evidence based by 2020 (Institute of Medicine, 2008). Unfortunately it can take up to 15-20 years for newly discovered treatments to be implemented into patient care (Institute of Medicine, 2001). Healthcare providers continue to base healthcare decisions on outdated practices derived from tradition or what they learned years ago in the academic setting (Melnyk et al., 2021). Because nurses are the nation’s largest healthcare profession, they have a front line view of patient care problems that need to be addressed (Friesen et al., 2017). Nurses are positioned to be leaders in identification and implementation of EBP to address those problems. Implementation of EBP can be challenging due to a process that can be viewed as complex and is reliant upon an organization that supports a culture of EBP (Melnyk & Fineout-Overholt, 2016; Saunders et al., 2016)

Potential health impacts of heavy metals on HIV-infected population in USA.

Noninfectious comorbidities such as cardiovascular diseases have become increasingly prevalent and occur earlier in life in persons with HIV infection. Despite the emerging body of literature linking environmental exposures to chronic disease outcomes in the general population, the impacts of environmental exposures have received little attention in HIV-infected population. The aim of this study is to investigate whether individuals living with HIV have elevated prevalence of heavy metals compared to non-HIV infected individuals in United States. We used the National Health and Nutrition Examination Survey (NHANES) 2003-2010 to compare exposures to heavy metals including cadmium, lead, and total mercury in HIV infected and non-HIV infected subjects. In this cross-sectional study, we found that HIV-infected individuals had higher concentrations of all heavy metals than the non-HIV infected group. In a multivariate linear regression model, HIV status was significantly associated with increased blood cadmium (p=0.03) after adjusting for age, sex, race, education, poverty income ratio, and smoking. However, HIV status was not statistically associated with lead or mercury levels after adjusting for the same covariates. Our findings suggest that HIV-infected patients might be significantly more exposed to cadmium compared to non-HIV infected individuals which could contribute to higher prevalence of chronic diseases among HIV-infected subjects. Further research is warranted to identify sources of exposure and to understand more about specific health outcomes

Tracking of Spall Deterioration on Tapered Roller Bearings

Fatigue spall initiation is one of the major modes of premature bearing failure. The spall initiation is often exacerbated by the presence of impurities in the near-surface region (∼400 μm) of the bearing raceways. Once a spall initiates, it can propagate rapidly, leading to abnormal bearing operation and possible catastrophic failure if not detected early. Testing performed at the University of Texas-Pan American (UTPA) has focused on ultrasonically scanned tapered roller bearings found to have inclusion content within 400 μm of the surface of the raceways. These bearings undergo accelerated service life tests in which spall initiation is detected and tracked over time while documenting spall growth. The work presented here provides several study cases that document the spall initiation and propagation on ultrasonically scanned tapered roller bearing components. Results show that spalls generally initiate on locations corresponding to sites of subsurface inclusions, and they grow many times their original size within relatively short operating periods. The study also shows that spalls tend to initiate and propagate at a faster rate on bearing cups (outer rings) than on cones (inner rings)

Geostatistical and stochastic study of flow and tracer transport in the unsaturated zone at Yucca Mountain

Yucca Mountain has been proposed by the U.S. Department of Energy as the nation’s long-term, permanent geologic repository for spent nuclear fuel or high-level radioactive waste. The potential repository would be located in Yucca Mountain’s unsaturated zone (UZ), which acts as a critical natural barrier delaying arrival of radionuclides to the water table. Since radionuclide transport in groundwater can pose serious threats to human health and the environment, it is important to understand how much and how fast water and radionuclides travel through the UZ to groundwater. The UZ system consists of multiple hydrogeologic units whose hydraulic and geochemical properties exhibit systematic and random spatial variation, or heterogeneity, at multiple scales. Predictions of radionuclide transport under such complicated conditions are uncertain, and the uncertainty complicates decision making and risk analysis. This project aims at using geostatistical and stochastic methods to assess uncertainty of unsaturated flow and radionuclide transport in the UZ at Yucca Mountain. Focus of this study is parameter uncertainty of hydraulic and transport properties of the UZ. The parametric uncertainty arises since limited parameter measurements are unable to deterministically describe spatial variability of the parameters. In this project, matrix porosity, permeability and sorption coefficient of the reactive tracer (neptunium) of the UZ are treated as random variables. Corresponding propagation of parametric uncertainty is quantitatively measured using mean, variance, 5th and 95th percentiles of simulated state variables (e.g., saturation, capillary pressure, percolation flux, and travel time). These statistics are evaluated using a Monte Carlo method, in which a three-dimensional flow and transport model implemented using the TOUGH2 code is executed with multiple parameter realizations of the random model parameters

Ly alpha emitting galaxies as early stages in galaxy formation

We present optical spectroscopy of two samples of GALEX grism selected Ly alpha emitters (LAEs): one at z=0.195-0.44 and the other at z=0.65-1.25. We have also observed a comparison sample of galaxies in the same redshift intervals with the same UV magnitude distributions but with no detected Ly alpha. We use the optical spectroscopy to eliminate active galactic nuclei (AGNs) and to obtain the optical emission-line properties of the samples. We compare the luminosities of the LAEs in the two redshift intervals and show that there is dramatic evolution in the maximum Ly alpha luminosity over z=0-1. Focusing on the z=0.195-0.44 samples alone, we show that there are tightly defined relations between all of the galaxy parameters and the rest-frame equivalent width (EW) of H alpha. The higher EW(H alpha) sources all have lower metallicities, bluer colors, smaller sizes, and less extinction, consistent with their being in the early stages of the galaxy formation process. We find that 75 +- 12% of the LAEs have EW(H alpha)>100 Angstrom, and, conversely, that 31 +/- 3% of galaxies with EW(H alpha)>100 Angstrom are LAEs. We correct the broadband magnitudes for the emission-line contributions and use spectral synthesis fits to estimate the ages of the galaxies. We find a median age of 1.1x10^{8} yr for the LAE sample and 1.4x10^{9} yr for the UV-continuum sample without detected Ly alpha. The median metallicity of the LAE sample is 12+log(O/H)=8.24, or about 0.4 dex lower than the UV-continuum sample.Comment: to be published in the Astrophysical Journa

Correlates of patient satisfaction and provider trust after breast-conserving surgery

BACKGROUND Although breast-conserving therapy (BCS) is considered the standard of care for early-stage breast cancer, up to 20% of patients are dissatisfied. The effect of treatment-related factors on patient satisfaction with their healthcare experiences is unclear. METHODS All BCS patients at the University of Michigan Medical Center who were treated between January 2002 and May 2006 were surveyed (n = 714; response rate, 79.5%). Patients were queried regarding 4 aspects of their decision for surgery: satisfaction with the decision, decision regret, decisional conflict, and trust in surgeons. Independent variables included the number of re-excisions, the occurrence of postoperative complications, and postoperative breast appearance, which was assessed by using the Breast Cancer Treatment and Outcomes scale. Multiple logistic regression was used to assess the effect of the independent variables on each outcome controlling for demographic and clinical characteristics. RESULTS Breast asymmetry after BCS was correlated significantly with patient satisfaction with their treatment experiences and patient distrust in surgeons. Women who reported pronounced asymmetry were significantly less likely to be satisfied with the decision for surgery compared with women who reported minimal asymmetry (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.21–0.89). Women with pronounced asymmetry were less likely to be certain about their surgical decision (OR, 0.36; 95% CI, 0.21–0.60) and to believe that they were prepared to make the decision for surgery (OR, 0.25; 95% CI, 0.14–0.43). Increasing breast asymmetry was associated with higher surgeon distrust scores (2.14 vs 2.30 vs 2.35; P = .04) and with the occurrence of postoperative complications (distrust score: 2.23 vs 2.35; P = .03). Reoperation after BCS was not associated with patient satisfaction or trust in providers. CONCLUSIONS Esthetic result after BCS was associated more profoundly with aspects of satisfaction than either surgical therapy or the occurrence of postoperative complications. The current findings indicated that surgeons who care for patients with breast cancer should identify the women at an increased risk for breast asymmetry preoperatively to effectively address their expectations of treatment outcomes. Cancer 2008. © 2008 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58592/1/23351_ftp.pd

Calmodulin and PI(3,4,5)P3 cooperatively bind to the Itk pleckstrin homology domain to promote efficient calcium signaling and IL-17A production

Precise regulation of the kinetics and magnitude of Ca2+ signaling enables this signal to mediate diverse responses, such as cell migration, differentiation, vesicular trafficking, and cell death. Here, we showed that the Ca2+-binding protein calmodulin (CaM) acted in a positive feedback loop to potentiate Ca2+ signaling downstream of the Tec kinase family member Itk. Using NMR (nuclear magnetic resonance), we mapped CaM binding to two loops adjacent to the lipid-binding pocket within the Itk pleckstrin homology (PH) domain. The Itk PH domain bound synergistically to Ca2+/CaM and the lipid phosphatidylinositol-3,4,5-trisphosphate [PI(3,4,5)P3], such that binding to Ca2+/CaM enhanced the binding to PI(3,4,5)P3 and vice versa. Disruption of CaM binding attenuated Itk recruitment to the membrane and diminished release of Ca2+ from the endoplasmic reticulum. Moreover, disruption of this feedback loop abrogated Itk-dependent production of the proinflammatory cytokine IL-17A (interleukin-17A) by CD4+ T cells. Additionally, we found that CaM associated with PH domains from other proteins, indicating that CaM may regulate other PH domain–containing proteins