New graduate nurses\u27 perceptions of simulation training

New graduate nurses enter practice with basic critical thinking skills and have minimal experience applying learned concepts into clinical practice. Hiring institutions aim orientation programs at developing new graduate nurses\u27 skills so that they are better prepared to meet patient needs. Human Patient Simulation is one tool employers have recently begun using. A qualitative study was conducted to gain insight into seven new graduate nurses\u27 perceptions of utilizing simulated mock code training during the orientation process. Analysis of the focus group discussion identified four emerging themes: Developing Confidence, Developing Knowledge Base, Developing Critical Thinking, and Developing a Sense of Realism. Each of the four emerging themes contained sub-themes. This research showed that simulation can be a beneficial tool to assist with the new graduate nurse transition into the workforce with the right facilitator and proper safeguards to ensure a sense of realism in the HPS and simulation environment

Foreword

Background: This study compares the levels of algesic substances between subjects with trapezius myalgia (TM) and healthy controls (CON) and explores the multivariate correlation pattern between these substances, pain, and metabolic status together with relative blood flow changes reported in our previous paper (Eur J Appl Physiol 108: 657-669, 2010). Methods: 43 female workers with (TM) and 19 females without (CON) trapezius myalgia were - using microdialysis - compared for differences in interstitial concentrations of interleukin-6 (IL-6), bradykinin (BKN), serotonin (5-HT), lactate dehydrogenas (LDH), substance P, and N-terminal propeptide of procollagen type I (PINP) in the trapezius muscle at rest and during repetitive/stressful work. These data were also used in multivariate analyses together with previously presented data (Eur J Appl Physiol 108: 657-669, 2010): trapezius muscle blood flow, metabolite accumulation, oxygenation, and pain development and sensitivity. Results: Substance P was significantly elevated in TM (p=0.0068). No significant differences were found in the classical algesic substances (p: 0.432-0.926). The multivariate analysis showed that blood flow related variables, interstitial concentrations of metabolic (pyruvate), and algesic (BKN and K+) substances were important for the discrimination of the subjects to one of the two groups (R-2: 0.19-0.31, pless than0.05). Pain intensity was positively associated with levels of 5-HT and K+ and negatively associated with oxygenation indicators and IL-6 in TM (R-2: 0.24, pless than0.05). A negative correlation existed in TM between mechanical pain sensitivity of trapezius and BKN and IL-6 (R-2: 0.26-0.39, pless than0.05). Conclusion: The present study increased understanding alterations in the myalgic muscle. When considering the system-wide aspects, increased concentrations of lactate, pyruvate and K+ and decreased oxygenation characterized TM compared to CON. There are three major possible explanations for this finding: the workers with pain had relatively low severity of myalgia, metabolic alterations preceded detectable alterations in levels of algesics, or peripheral sensitization and other muscle alterations existed in TM. Only SP of the investigated algesic substances was elevated in TM. Several of the algesics were of importance for the levels of pain intensity and mechanical pain sensitivity in TM. These results indicate peripheral contribution to maintenance of central nociceptive and pain mechanisms and may be important to consider when designing treatments.Funding Agencies|Danish Medical Research Council [22-03-0264]; Danish Rheumatism Association [233-1149-02.02.04]; Swedish Research Council [K2011-69X-21874-01-6]; Swedish Council for Working Life and Social Research [2010-0913]</p

Data Recovery at Justiceburg Reservoir (Lake Alan Henry), Garza and Kent Counties, Texas: Phase III, Season 1

Phase III data recovery investigations at one historic and three prehistoric sites, augmented by additional survey and off-site geological investigations, were conducted at Lake Alan Henry (formerly Justiceburg Reservoir) on the Double Mountain Fork of the Brazos River in Garza and Kent counties, Texas, during the fall and winter of 1990-1991. Descriptive data from this first of three field seasons of data recovery are presented here in anticipation of a final synthetic report that will relate all the investigations to a series of research design hypotheses. Analysis of surface distributions at 41KT42, a late nineteenth- to early twentieth-century ranch line camp known locally as the Ed Scott Cabin, groups the artifacts into material and functional categories that demonstrate primary and secondary refuse accumulations adjacent to the cabin. The distribution of primary refuse shows kitchen artifacts are spatially distinct from other types that include architectural, firearm, ranching, clothing, and personal items. The primary discard pattern is obfuscated by redistribution attributed to secondary refuse discard. The uppermost of two superimposed hearths at 41GR484, the Grape Creek Bench Site, is radiocarbon dated to 260 B.P. and yielded charcoal identified as Carya sp. Excavations were halt~d at this Late Prehistoric II site because of extremely low artifact recovery. Geoarcheological investigations demonstrate that most of the site has been destroyed by cutbank erosion associated with the meanderings of Grape Creek. At 41KT33, the Late Prehistoric I South Sage Creek Site, stone-lined hearth features dated to 1005 B.P. are surrounded by clusters of artifacts. Petrographic analysis of brownware ceramics suggests affiliations with the local Palo Duro Complex and nonlocally with the Pecos River valley. The Gobbler Creek Bridge Site, 4IGR383, spans the late Archaic and Late Prehistoric I periods. Intact· and dispersed stone-lined hearths radiocarbon dated to 1865-1215 B.P. are surrounded by artifact clusters. Both of the sites appear to have been multifunctional campsites, and repeated occupations are likely. Dense concentrations of fire-cracked rocks at these sites may represent secondary refuse disposal. Lithic analysis indicates extensive use of nonlocal materials derived from Cretaceous formations that occur in the Callahan Divide and Edwards Plateau to the south. Freshwater mussels are the only faunal remains recovered from either of these sites. The meat is presumed to have been consumed as food, while the shells sometimes were made into ornaments. An additional 440 acres of land were surveyed for cultural resources; 360 of these acres were subsequently acquired by the City of Lubbock for use as wildlife mitigation lands. Nine prehistoric archeological sites and one isolated fmd were documented and evaluated for their eligibility for listing on the National Register of Historic Places. Five of these sites are considered to be ineligible for listing on the National Register, and five are potentially eligible for listing. Avoidance is recommended at these five sites, with testing recommended to determine their National Register eligibility if avoidance is not possible. Geological investigations provide information about depositional environments in and near the archeological sites. Two soils buried in the Double Mountain Fork floodplain are radiocarbon dated to 8~00 B.P. and 1700-1300 B.P.; fluvial sediments extend as much as 15 m below these soils in portions of the floodplain. An older terrace previously was identified 18 m above the modem river channel. Current work obtained a terminal date of 8690 B.P. from a buried soil that caps this older terrace. Another radiocarbon date of 3320 B.P. was obtained from fill in a gully that is eroded into the older terrace. These dates bracket an erosional episode when the older terrace was heavily dissected. The erosion coincides with the Altithermal, a period believed to have been characterized by a hot and dry climatic regime

An investigation of BMP-7 mediated alterations to BMP signalling components in human tenocyte-like cells

The incidence of tendon re-tears post-surgery is an ever present complication. It is suggested that the application of biological factors, such as bone morphogenetic protein 7 (BMP-7), can reduce complication rates by promoting tenogenic characteristics in in vitro studies. However, there remains a dearth of information in regards to the mechanisms of BMP-7 signalling in tenocytes. Using primary human tenocyte-like cells (hTLCs) from the supraspinatus tendon the BMP-7 signalling pathway was investigated: induction of the BMP associated Smad pathway and non-Smad pathways (AKT, p38, ERK1/2 and JNK); alterations in gene expression of BMP-7 associated receptors, Smad pathway components, Smad target gene (ID1) and tenogenic marker scleraxis. BMP-7 increases the expression of specific BMP associated receptors, BMPR-Ib and BMPR-II, and Smad8. Additionally, BMP-7 activates significantly Smad1/5/8 and slightly p38 pathways as indicated by an increase in phosphorylation and proven by inhibition experiments, where p-ERK1/2 and p-JNK pathways remain mainly unresponsive. Furthermore, BMP-7 increases the expression of the Smad target gene ID1, and the tendon specific transcription factor scleraxis. The study shows that tenocyte-like cells undergo primarily Smad8 and p38 signalling after BMP-7 stimulation. The up-regulation of tendon related marker genes and matrix proteins such as Smad8/9, scleraxis and collagen I might lead to positive effects of BMP-7 treatment for rotator cuff repair, without significant induction of osteogenic and chondrogenic markers

Defining consensus norms for palliative care of people with intellectual disabilities in Europe using Delphi methods: A White Paper from the European Association of Palliative care

This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice

חוקוק – 2014: דוח ראשוני [Huqoq – 2014: Preliminary Report]

During the month of June 2014, a fourth season of excavations was conducted at Horbat Huqoq in eastern Galilee (License No. G-16/2014; map ref. 245198/754556; Magness 2012; Magness et al. 2013; Magness et al. 2014). The excavations were undertaken and underwritten by the University of North Carolina at Chapel Hill, Brigham Young University (Utah), Trinity University (Texas) and the University of Toronto (Canada). Additional funding was provided by Dumbarton Oaks (Washington, D.C.), The Foundation for Biblical Archaeology (S. Bishop) and private donors. The excavation was directed by J. Magness, with the assistance of S. Kisilevitz (assistant director), M. Golan (administration), C. Spigel, M. Grey, and B. Gordon (area supervision), T. De’adle (consultant on the modern village), B. Coussens (assistant area supervisor), J. Bucko (surveying), J. Haberman (field photography), M. Robinson-Mohr (registration), D. Schindler (ceramics), K. Britt (mosaics), M. Belmaker (rodent remains), J. George (paleobotany), C. Swan (glass), N. Elkins (numismatics), P. Flesher (computer data and educational program), R. Mohr (drawing), V. Pirsky (drafting), O. Cohen (site conservation) and M. Lavie (cleaning and conservation of artifacts). Most of the volunteers were undergraduate and graduate students from the U.S.A. and Canada