Rural Hospital Nursing Skill Mix and Work Environment Associated with Frequency of Adverse Events.

Introduction: Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events. Objectives: The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals. Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential. Results: On average, 72% of nursing staff were RNs (range = 45% to 100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events. Conclusion: Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency

The Underrepresentation of Black Males in IT Higher Education: a Conceptual Framework for Understanding Individual Differences

Among the many research challenges in studying underrepresented groups in IT is understanding the appropriate theories to apply and much needed analysis at the individual level. This paper presents findings of two studies, which coupled with the application of the Individual Differences Theory of Gender and IT, led to a conceptual framework being developed to delve deeper into the understanding of Black males in IT higher education. The use of the conceptual framework will lead to a better understanding of the factors impacting underrepresented groups participation in IT

Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia.

BACKGROUND: In first-episode schizophrenia, longer duration of untreated psychosis (DUP) predicts poorer outcomes. AIMS: To address whether the relationship between DUP and outcome is a direct causal one or the result of association between symptoms and/or cognitive functioning and social functioning at the same time point. METHOD: Symptoms, social function and cognitive function were assessed in 98 patients with first-episode schizphrenia at presentation and 1 year later. RESULTS: There was no significant clinical difference between participants with short and long DUP at presentation. Linear regression analyses revealed that longer DUP significantly predicted more severe positive and negative symptoms and poorer social function at 1 year, independent of scores at presentation. Path analyses revealed independent direct relationships between DUP and social function, core negative symptoms and positive symptoms. There was no significant association between DUP and cognition. CONCLUSIONS: Longer DUP predicts poor social function independently of symptoms. The findings underline the importance of taking account of the phenomenological overlap between measures of negative symptoms and social function when investigating the effects of DUP

Lack of Z-DNA Conformation in Mitomycin-Modified Polynucleotides Having Inverted Circular Dichroism

Poly(dG-dC)· poly(dG-dC) and Micrococcus lysodeikticus DNA were modified by exposure to reductively activated mitomycin C, an antitumor antibiotic. The resulting covalent drug-polynucleotide complexes displayed varying degrees of CD inversions, which are strikingly similar to the inverted spectrum observed with Z-DNA. The following criteria have been used to establish, however, that the inverted CD pattern seen in mitomycin C-polynucleotide complexes does not reflect a Z-DNA conformation. (i) The ethanol-induced transition of poly(dG-dC)· poly(dG-dC) from B to Z conformation is not facilitated but rather is inhibited by mitomycin C modification. This may be due to the presence of crosslinks. (ii) Radioimmunoassay indicated no competition for Z-DNA-specific antibody by any of the mitomycin C-modified polynucleotides. (iii) 31P NMR of the complexes yielded a single relatively narrow resonance, which is inconsistent with the dinucleotide repeat characteristic of Z-DNA. Alternative explanations for the inverted CD pattern include a drug-induced left-handed but non-Z conformational change or the superposition of an induced CD onto the CD of B-DNA due to drug-base electronic interactions. These results illustrate the need for caution in interpreting CD changes alone as an indication of Z-DNA conformation

Exploring Patient-Provider Relationships in Preference-Based Health Care Choices

Patient-physician relationship models previously identified in research do not always capture the full range of consumers’ experiences as they engage in difficult, preference-based decisions. Examining the context of individuals seeking infertility treatment, we identify a new Peripheral Model of patient-physician relationship, whereby the physician’s role is perceived as rather inconsequential

An Observational Analysis of Meal Patterns in Overweight and Obese Pregnancy

Background Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI. Aim To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes. Methods Prospective, observational analysis of pregnant women (n = 143) (BMI 25–39.9 kg/m2). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks’ gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry. Results Three meal pattern categories were identified: ‘main meal dominant’ (3 main eating occasions + 0–3 snacks), ‘large meal dominant’ (≤ 2 main eating occasions + \u3c 2 snacks), and ‘snack dominant’ (3 main eating occasions + \u3e 3 snacks and ≤2main + ≥ 2 snacks). A main meal–dominant pattern prevailed at 16 weeks’ (85.3%) and a snack-dominant pattern at 28 weeks’ (68.5%). Dietary glycaemic index was lower among the main meal versus large meal–dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal–dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively). Conclusion Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal–dominant to snack-dominant patterns. Large meal–dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia

Genesis capsule yields solar wind samples

NASA's Genesis capsule, carrying the first samples ever returned from beyond the Moon, took a hard landing in the western Utah desert on 8 September after its parachutes failed to deploy Despite the impact, estimated at 310 km per hour, some valuable solar wind collector materials have been recovered. With these samples, the Genesis team members are hopeful that nearly all of the primary science goals may be met. The Genesis spacecraft was launched in August 2001 to collect and return samples of solar wind for precise isotopic and elemental analysis. The spacecraft orbited the Earth-Sun Lagrangian point (LI), ˜1.5 million km sunward of Earth, for 2.3 years. It exposed ultrapure materials—including wafers of silicon, silicon carbide, germanium, chemically deposited diamond, gold, aluminum, and metallic glass— to solar wind ions, which become embedded within the substrates' top 100 nm of these materials

Transcriptomes of parents identify parenting strategies and sexual conflict in a subsocial beetle

This work was funded by UK NERC grants to M.G.R. and A.J.M. an NERC studentship to D.J.P. the University of Georgia and a US NSF grant to A.J.M. and M.G.R.Parenting in the burying beetle Nicrophorus vespilloides is complex and, unusually, the sex and number of parents that can be present is flexible. Such flexibility is expected to involve specialized behaviour by the two sexes under biparental conditions. Here, we show that offspring fare equally well regardless of the sex or number of parents present. Comparing transcriptomes, we find a largely overlapping set of differentially expressed genes in both uniparental and biparental females and in uniparental males including vitellogenin, associated with reproduction, and takeout, influencing sex-specific mating and feeding behaviour. Gene expression in biparental males is similar to that in non-caring states. Thus, being ‘biparental’ in N. vespilloides describes the family social organization rather than the number of directly parenting individuals. There was no specialization; instead, in biparental families, direct male parental care appears to be limited with female behaviour unchanged. This should lead to strong sexual conflict.Publisher PDFPeer reviewe

Long-term sensorimotor changes after a sciatic nerve block with bupivacaine and liposomal bupivacaine in a high-fat diet/low-dose streptozotocin rodent model of diabetes

IntroductionIt is unclear whether patients with diabetes are more susceptible to nerve toxicity of local anesthetics or whether nerve blocks can accelerate the progression of diabetic peripheral neuropathy. Bupivacaine is one of the most widely used local anesthetics for regional anesthesia despite many pre-clinical studies demonstrating neurotoxicity. Herein, we report the long-term functional consequences of sciatic nerve block with bupivacaine and liposomal bupivacaine (Exparel®) in an animal model of diabetes.MethodsMale Sprague Dawley rats were subject to standard chow/vehicle or high-fat diet/low-dose streptozotocin to induce a diabetic phenotype. Animals were then subdivided into groups that received repeated sciatic nerve blocks of saline, bupivacaine, or liposomal bupivacaine. Mechanical allodynia and thermal hyperalgesia were assessed prior to and 12 weeks following nerve blocks utilizing the von Frey and Hargreaves tests, respectively. Exploratory and locomotor activity were assessed with open field testing, and nerve conduction velocity testing was conducted prior to the termination of the study at 28 weeks.ResultsAnimals in the diabetic group developed sustained hyperglycemia >200 mg/dl and signs of peripheral neuropathy six weeks after treatment with streptozotocin, which persisted until the end of the study. Twelve weeks after a repeated sciatic nerve block with saline, bupivacaine, or liposomal bupivacaine, results indicate significant interaction effects of the disease group (control vs. diabetic) and local anesthetic treatment. Overall, diabetic status resulted in worse sensorimotor function compared to control animals. Treatment with perineural bupivacaine resulted in worse sensorimotor functions in both control and diabetic animals. Furthermore, bupivacaine treatment in diabetic animals with pre-existing neuropathy exacerbated sensorimotor function in some measures. In contrast, liposomal bupivacaine did not appear to cause any negative effects on functional outcomes for control or diabetic animals.ConclusionOur data indicate that bupivacaine, and not liposomal bupivacaine, causes long-term changes in tactile allodynia, thermal hyperalgesia, locomotor behaviors, and nerve conduction velocity in control as well as a high-fat diet/low-dose streptozotocin rodent model of diabetes. These results highlight the necessity to investigate safe peripheral nerve block strategies to preserve long-term functional independence in patients with or at risk for diabetic peripheral neuropathy