Are Rural and Urban Newly Licensed Nurses Different? A Longitudinal Study of a Nurse Residency Programme

Aim This study aimed to compare rural and urban nurse residency programme participants’ personal and job characteristics and perceptions of decision-making, job satisfaction, job stress, nursing performance and organisational commitment over time. Background Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses. Method A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme. Results At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar. Conclusions Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration. Implications for nursing management Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy

Answering Wicked Questions: Dealing With Opposing Truths as a Nursing Associate Professor

Nursing associate professors frequently are confronted with increasing responsibilities and fewer resources. These challenges commonly contribute to declines in job satisfaction and may result in departing academe. This article addresses these challenges by providing answers to four common “wicked questions” experienced by nursing associate professors: (a) How do I decline a request from a supervisor to take on additional responsibilities while continuing to support the mission of the school and advance my own scholarly productivity? (b) How do I handle the workload of multiple doctoral students with a variety of content areas that are different from my own and maintain my own level of productivity? (c) How do I handle expectations for more service, and leadership for the school, university, and professional organizations, yet the teaching and research responsibilities have not changed or have increased? and (d) What are some additional tips to being a more productive nursing associate professor

Continued development of doped-germanium photoconductors for astronomical observations at wavelengths from 30 to 120 micrometers

The development of doped-germanium detectors which have optimized performance in the 30- to 120-mu m wavelength range and are capable of achieving the objectives of the infrared astronomical satellite (IRAS) space mission is discussed. Topics covered include the growth and evaluation of Ge:Ga and Ge:Be crystals, procedures for the fabrication and testing of detectors, irradiance calculations, detector responsivity, and resistance measurements through MOSFET. Test data are presented in graphs and charts

The two-year impact of first generation protease inhibitor based antiretroviral therapy (PI-ART) on health-related quality of life

BACKGROUND: Protease inhibitor based antiretroviral therapy (PI-ART) was introduced in 1996 and has greatly reduced the incidence of HIV-related morbidity and mortality in the industrialised world. PI-ART would thus be expected to have a positive effect on health-related quality of life (HRQL). On the other hand, HRQL might be negatively affected by strict adherence requirements as well as by short and long-term adverse effects. The aim of this study was to assess the influence of two years of first generation PI-ART on HRQL in patients with a relatively advanced state of HIV-infection. Furthermore, we wanted to investigate the relation between developments in HRQL and viral response, self-reported adherence and subjective experience of adverse effects in patients with PI-ART. METHODS: HRQL was measured by the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). Sixty-three items from the SWED-QUAL forms two single-item and 11 multi-item dimension scales. For this study, two summary SWED-QUAL scores (physical HRQL composite score and emotional HRQL composite score) were created through a data reduction procedure. At the 2-year follow-up measurement (see below), items were added to measure adherence and subjective experience of adverse effects. Demographic and medical data were obtained from specific items in the questionnaires and from the medical files. Seventy-two patients who were among the first to receive PI-ART (indinavir or ritonavir based) responded to the questionnaire before the start of PI-ART. Of these, 54 responded to the same instrument after two years of treatment (13 had died, four had changed clinic and one did not receive the questionnaire). RESULTS: The main findings were that the emotional HRQL deteriorated during two years of PI-ART, while the physical HRQL remained stable. Multiple linear regression analyses showed that experience of adverse effects contributed most to the deterioration of emotional HRQL. CONCLUSION: In this sample of patients with relatively advanced state of HIV-infection, our data suggested that a negative development of physical HRQL had been interrupted by the treatment and that the emotional dimension of HRQL deteriorated during two years after start of PI-ART. Subjective experience of adverse effects made a major contribution to the decrease in emotional HRQL. The results underline the importance of including HRQL measures in the evaluation of new life prolonging therapies

Sexually transmitted infections (STI) in men who have sex with men (MSM)

The impact of increasingly efficient antiretroviral therapy (ART) on survival and general well-being has contributed to a "business as usual" attitude to sex among men who have sex with men (MSM). There has been a recent marked increase of sexually transmitted infections (STI) including syphilis, LGV and Hepatits C among MSM. STIs located in the oral cavity or rectum are asymptomatic in over 80% and 50%, respectively and these sites must be seen as important reservoirs. On the other hand severe proctitis may be mistreated as inflammatory bowel disease without adequate medical history and testing. Due to the reappearance of syphilis, all genital ulcers, non-itching exanthema and severe disease symptoms (e.g. fever, fatigue, lymphadenopathy, hepato-splenomegaly, increased liver enzymes, neurological and ophthalmologic symptoms without other explanations) should lead to testing for syphilis. There is a marked association between STIs and HIV. Syphilis, LGV and Hepatits C are strongly overrepresented in HIV positive MSM, while gonorrhoea, LGV and syphilis increase the HIV susceptibility. Syphilis leads to increased viral load in HIV positive. The major risk factors for Hepatitis B are number of sex partners and receptive anal intercourse. High grade Human Papilloma Virus (HPV) anal lesions can progress to cancer. There is a 30 fold increase risk for anal cancer among MSM, a risk that is doubled in HIV infection, making anal cancer one of the most common non-AIDS tumors. All MSM should be offered Hepatitis A and B vaccination and the inclusion of boys in HPV vaccination programs must be considered. The aim of this article is to describe asymptomatic and symptomatic bacterial and viral STIs of the oral cavity, penis/urethra and rectum and the sexually transmittable viral Hepatitis and HIV in MSM and to inspire the medical establishment to adhere to testing guidelines in this group. This article is built on a review of published findings, the presentation of own data on Gonorrhoea and chlamydia and our own experience in treating all STIs including HIV in MSM since 1982 at a Gay Men's Health Clinic (Venhälsan) at Stockholm South General Hospital, Sweden

MICROBIAL BASED CHLORINATED ETHENE DESTRUCTION

A mixed culture of Dehalococcoides species is provided that has an ability to catalyze the complete dechlorination of polychlorinated ethenes such as PCE, TCE, cDCE, 1,1-DCE and vinyl chloride as well as halogenated ethanes such as 1,2-DCA and EDB. The mixed culture demonstrates the ability to achieve dechlorination even in the presence of high source concentrations of chlorinated ethenes

Lipoatrophy of the footpad in HIV-treated patients is associated with increased PAI-1

Purpose: To describe lipoatrophy of the plantar pedis fat pads in HIV patients with or without long-term antiretroviral therapy (ART); to compare the characteristics of ART patients with and without plantar pedis lipoatrophy; and to examine the effects of HIV and metabolic/cardiovascular risk parameters and treatment history on plantar pedis lipoatrophy. Design: One hundred and thirty four patients who started PI-ART in 1996 and 49 treatment naïve patients, recruited 2004, were examined and graded for lipoatrophy of five body compartments including the plantar fat pads eight years after start of ART. Baseline HIV- and ART-related factors were documented together with follow up metabolic/cardiovascular risk parameters. Results: Plantar pedis lipoatrophy occurred more often among ART patients (60%) than among treatment naïve patients (12%; p <0.001). ART patients with plantar lipoatrophy were older, had higher PAI-1 values, a higher prevalence of lipoatrophy in other body compartments, and longer stavudine and didanosine treatment history as compared to patients without plantar lipoatrophy. In multiple logistic regression, the best predictive model for plantar lipoatrophy was increased PAI-1 when HIV and metabolic/cardiovascular risk parameters were studied and treatment with didanosine when treatment history was studied. Increased PAI-1 was not associated to lioatrophy in any other location. Conclusions: Plantar lipoatrophy is common among patients on long-term ART and, although often overlooked, may cause significant discomfort. The association to PAI-1, a well known marker of increased cardiovascular risk, is intriguing and further focuses on the need of an active approach to evaluating and lowering cardiovascular risk factors in long-term HIV treatment