Strategies nurse educators use to integrate computer -assisted instruction into their courses to teach clinical decision-making

The strategies nurse educators\u27 use to integrate computer-assisted instruction (CAI) designed to teach clinical decision-making into their courses were investigated to determine their frequency of use and effectiveness. The Integration of CAI Questionnaire, an on-line electronic survey designed by the investigator, was used to collect data. A stratified randomly-selected group of 109 schools of nursing that was a statistically representative mix of baccalaureate (BSN), associate (AD) and diploma schools from each of six geographic regions of the United States comprised the sample.;The study questions were as follows: (1) What integration strategies have nurse educators used to integrate CAI? (2) How effective did participants perceive the strategies were for increasing student learning, decreasing course costs, students\u27 time and the teachers\u27 time? (3) What were the key features of the schools and educators that integrated CAI effectively? (4) What types of software did nurse educators use to teach clinical decision-making? (5) How effective were their peers at integrating the software and how effectively did they integrate commercially-purchased and in-house produced software?;Statistical analysis consisted of measures of central tendency, frequencies, and percentages. The Pearson r was used to determine the relationships between the frequency of use and perceptions of the effectiveness of the strategies.;The findings showed that 71% of the schools used CAI and that more AD (81%) and diploma schools (80%) used CAI than BSN (56%). In fact, AD schools and teachers used CAI more on most measures and rated their peers as more effective at integrating CAI than their BSN counterparts. Twenty-nine of the 44 strategies were frequently used and 17 were perceived to be effective. Significant correlations (p \u3c 0.01) were noted for explain CAI, explain objectives, motivate, integrate, individual mode, course exam and follow-up. Technical and instructional support were the two most frequently used and effective strategies for increasing learning and decreasing students\u27 and teachers\u27 time but not costs. BSN schools used more strategies frequently but almost no differences in AD and BSN participants\u27 perceptions of effectiveness were noted. Tutorials and drill-and-practice programs were used most and 95% of the programs were commercially-purchased

Hemoglobin variants identified in the Uganda Sickle Surveillance Study

The Uganda Sickle Surveillance Study analyzed dried blood spots that were collected from almost 100 000 infants and young children from all 10 regions and 112 districts in the Republic of Uganda, with the primary objective of determining the prevalence of sickle cell trait and disease. An overall prevalence of 13.3% sickle cell trait and 0.7% sickle cell disease was recently reported. The isoelectric focusing electrophoresis technique coincidentally revealed numerous hemoglobin (Hb) variants (defined as an electrophoresis band that was not Hb A, Hb F, Hb S, or Hb C) with an overall country-wide prevalence of 0.5%, but with considerable geographic variability, being highest in the northwest regions and districts. To elucidate these Hb variants, the original isoelectric focusing (IEF) gels were reviewed to identify and locate the variant samples; corresponding dried blood spots were retrieved for further testing. Subsequent DNA-based investigation of 5 predominant isoelectric focusing patterns identified 2 α-globin variants (Hb Stanleyville II, Asn78Lys; Hb G-Pest, Asp74Asn), 1 β-globin variant (Hb O-Arab, Glu121Lys), and 2 fusion globin variants (Hb P-Nilotic, β31-δ50; Hb Kenya, Aγ81Leu-β86Ala). Compound heterozygotes containing an Hb variant plus Hb S were also identified, including both Hb S/O-Arab and HbS/Kenya. Regional differences in the types and prevalence of these hemoglobin variants likely reflect tribal ancestries and migration patterns. Algorithms are proposed to characterize these Hb variants, which will be helpful for emerging neonatal hemoglobinopathy screening programs that are under way in sub-Saharan Africa

Reduction in carbon uptake during turn of the century drought in western North America

Fossil fuel emissions aside, temperate North America is a net sink of carbon dioxide at present¹⁻³. Year-to-year variations in this carbon sink are linked to variations in hydroclimate that affect net ecosystem productivity³,⁴. The severity and incidence of climatic extremes, including drought, have increased as a result of climate warming⁵⁻⁸. Here, we examine the effect of the turn of the century drought in western North America on carbon uptake in the region, using reanalysis data, remote sensing observations and data from global monitoring networks. We show that the area-integrated strength of the western North American carbon sink declined by 30–298 Tg C  yr⁻¹ during the 2000–2004 drought. We further document a pronounced drying of the terrestrial biosphere during this period, together with a reduction in river discharge and a loss of cropland productivity. We compare our findings with previous palaeoclimate reconstructions⁷ and show that the last drought of this magnitude occurred more than 800 years ago. Based on projected changes in precipitation and drought severity, we estimate that the present mid-latitude carbon sink of 177–623 Tg C yr⁻¹ in western North America could disappear by the end of the century.KEYWORDS: Hydrology, hydrogeology and limnology, Biogeochemistry, Climate scienc

Make a CHANGE: optimising communication and pain management decisions

Peer reviewe

MiR-34a Represses Numbl in Murine Neural Progenitor Cells and Antagonizes Neuronal Differentiation

MicroRNA (miRNA) function is required for normal animal development, in particular in differentiation pathways from stem cell and precursor populations. In neurogenesis, it is becoming increasingly appreciated that miRNAs act at many stages to ensure proper progression. In this study we examined the role of miR-34a in neural progenitor cells (NPC) derived from murine embryonic cortex. We found that over-expression of miR-34a in NPC significantly reduced the neuron yield upon in vitro induction of differentiation. MiR-34a has several predicted targets in the Notch pathway, which operates to balance progenitor self-renewal and differentiation during cortical neurogenesis. We tested several Notch pathway players for regulation by miR-34a in undifferentiated NPC, and found that mRNA and protein levels of Numbl, a negative regulator of Notch signaling, as well as two downstream pro-neural genes usually blocked by Notch signaling, NeuroD1 and Mash1, were diminished, while Notch1 and Cbf1 transcripts were enhanced by miR-34a over-expression. Using a luciferase reporter assay, we verified the Numbl 3′-UTR as a direct miR-34a target. Correspondingly, knock-down of endogenous miR-34a resulted in increased Numbl, NeuroD1 and Mash1, and reduced Notch1 transcript levels. Together these results implicate Numbl as a physiologically relevant target of miR-34a in NPC, allowing for enhanced Notch signaling and inhibition of neuronal differentiation. This work extends our understanding of miR-34a-mediated control of cell differentiation from cancer to mammalian nervous system development

Evaluation of continental carbon cycle simulations with North American flux tower observations

Terrestrial biosphere models can help identify physical processes that control carbon dynamics, including land–atmosphere CO₂ fluxes, and have great potential to predict the terrestrial ecosystem response to changing climate. The skill of models that provide continental-scale carbon flux estimates, however, remains largely untested. This paper evaluates the performance of continental-scale flux estimates from 17 models against observations from 36 North American flux towers. Fluxes extracted from regional model simulations were compared with co-located flux tower observations at monthly and annual time increments. Site-level model simulations were used to help interpret sources of the mismatch between the regional simulations and site-based observations. On average, the regional model runs overestimated the annual gross primary productivity (5%) and total respiration (15%), and they significantly underestimated the annual net carbon uptake (64%) during the time period 2000–2005. Comparison with site-level simulations implicated choices specific to regional model simulations as contributors to the gross flux biases, but not the net carbon uptake bias. The models performed the best at simulating carbon exchange at deciduous broadleaf sites, likely because a number of models used prescribed phenology to simulate seasonal fluxes. The models did not perform as well for crop, grass, and evergreen sites. The regional models matched the observations most closely in terms of seasonal correlation and seasonal magnitude of variation, but they have very little skill at interannual correlation and minimal skill at interannual magnitude of variability. The comparison of site vs. regional-level model runs demonstrated that (1) the interannual correlation is higher for site-level model runs, but the skill remains low; and (2) the underestimation of year-to-year variability for all fluxes is an inherent weakness of the models. The best-performing regional models that did not use flux tower calibration were CLM-CN, CASA-GFEDv2, and SIB3.1. Two flux tower calibrated, empirical models, EC-MOD and MOD17+, performed as well as the best process-based models. This suggests that (1) empirical, calibrated models can perform as well as complex, process-based models and (2) combining process-based model structure with relevant constraining data could significantly improve model performance.Keywords: model–data comparison, flux towers, terrestrial biosphere models, carbon fluxesKeywords: model–data comparison, flux towers, terrestrial biosphere models, carbon fluxe

A model-data comparison of gross primary productivity: Results from the North American Carbon Program site synthesis

Accurately simulating gross primary productivity (GPP) in terrestrial ecosystem models is critical because errors in simulated GPP propagate through the model to introduce additional errors in simulated biomass and other fluxes. We evaluated simulated, daily average GPP from 26 models against estimated GPP at 39 eddy covariance flux tower sites across the United States and Canada. None of the models in this study match estimated GPP within observed uncertainty. On average, models overestimate GPP in winter, spring, and fall, and underestimate GPP in summer. Models overpredicted GPP under dry conditions and for temperatures below 0°C. Improvements in simulated soil moisture and ecosystem response to drought or humidity stress will improve simulated GPP under dry conditions. Adding a low-temperature response to shut down GPP for temperatures below 0°C will reduce the positive bias in winter, spring, and fall and improve simulated phenology. The negative bias in summer and poor overall performance resulted from mismatches between simulated and observed light use efficiency (LUE). Improving simulated GPP requires better leaf-to-canopy scaling and better values of model parameters that control the maximum potential GPP, such as ε[subscript max] (LUE), V[subscript cmax] (unstressed Rubisco catalytic capacity) or J[subscript max] (the maximum electron transport rate)

Successful Use of Bortezomib in an Adolescent with Refractory TTP

With increasing early and upfront use of rituximab and caplacizumab in the modern management of immune-mediated thrombotic thrombocytopenic purpura (iTTP), the risk of refractory disease is expected to decline. However, despite the use of adequate initial therapy, a small subset of patients develop a refractory disease which is difficult to manage. Bortezomib has come to be known as a safe and effective treatment option for refractory iTTP, but its use in children is limited. Here, we describe the case of an adolescent patient with refractory iTTP who had a satisfactory and sustained response to the use of bortezomib

Knowledge insufficient: the management of haemoglobin SC disease.

Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC