Mixed-effects modeling of shortleaf pine (Pinus echinata Mill.) growth data

Scope and Methods of Study: The objective of this study was to develop individual-tree mixed-effects models for basal area growth and the diameter-height relationship of shortleaf pine (Pinus echinata Mill.). Repeated measurements for attributes including diameter at breast height and total height from over 200 permanent plots were available from eastern Oklahoma and western Arkansas. Models with plot random-effects were fitted using the S-Plus nlme library and SAS PROC NLMIXED utilizing a calibration dataset. Models with independently and normally distributed errors were fitted first. Then possible spatially correlated and/or heterogeneous within-plot errors were modeled for basal area growth. The most promising models were tested using an independently selected dataset from the same study.Results and Conclusions: Though increasingly popular in forestry, mixed-effects modeling technique has never previously been used in shortleaf pine growth modeling. Nonlinear mixed models with plot random-effects were found to fit the data better than the models fitted with a complete random sample assumption (the ordinary least-squares method) as reported in Lynch et al. (1999) for both a basal area growth model and a model for diameter-height relationship. Because data were grouped by plots, a mixed-effects model with plot-level random-effects was a more realistic representation of the data structure than ordinary least squares. Spatial correlation among tree measurements within a plot did not appear to be important in presence of plot random-effects. However, variance modeling using a variance function with tree basal area as a covariate accounted for heterogeneity of within-plot errors better than the modeling approach in which constant variance was assumed

Delirium point prevalence studies in inpatient settings: A systematic review

Aims: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management. Background: Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium. Design: A systematic review and meta-analysis. Methods: A systematic review of published delirium prevalence studies in inpatient settings was conducted and the implications of findings for delirium screening, assessment, prevention and management identified. The random-effects meta-analysis was conducted among studies measuring delirium point prevalence. The PRISMA statement was used to report systematic review and meta-analysis. Results: Nine studies were included in the review, with sample sizes ranging from 47–1867. Delirium point prevalence ranged from 9%–32%. Hypoactive delirium was the most common subtype, ranging from 23%–78%. Fifteen delirium screening tools or assessment or diagnostic methods were used. Comorbid dementia was present in up to 50% of inpatients. Conclusions: Gaining a consensus on effective delirium instruments, the time windows for assessment and measurement will be crucial in driving benchmarking and quality improvement studies

Auricular Point Acupressure Smartphone Application to Manage Chronic Musculoskeletal Pain: A Longitudinal, One-Group, Open Pilot Trial

Background: Chronic musculoskeletal pain (CMP) is the most common self-reported chronic pain condition. Current treatment for CMP is limited. Methods: This was a two-phase study. In Phase 1, three auricular point acupressure (APA)-naïve participants were recruited to explore their experiences of APA and a smartphone app was developed based on their feedback. In Phase 2, a prospective longitudinal study was used to examine the effectiveness of the smartphone app to self-manage CMP. Results: Phase 1 resulted in the successful development of the APA smartphone app. In Phase 2, after four weeks of APA, participants reported reduced pain intensity (30%), pain interference (35%), and disability (40%), as well as improved physical function (47%). The mean score for the participants’ perception of treatment efficacy was 4.94 (SD = 2.08, scale of 0–7) indicating that approximately 70% of participants rated global improvements with noticeable changes. The majority (88%, n = 22) of the participants were satisfied with the treatment: 32% [8] were very satisfied and 56% [n = 14] were somewhat satisfied. The average frequency of pressing APA seeds per day was 2.93 times (SD = 2.27, range 0–10) and 1.60 minutes per time (SD = 2.64, range 0–10); the participants were able to adhere to the suggested pressing time per day, although they only pressed the ear points about 53% of the suggested time. Conclusion: It is feasible for individuals to learn APA from the smartphone app and successfully self-administer APA to manage their pain. Participants found the app useful and were satisfied with the information provided through the app

Outcomes by Sex Following Treatment Initiation With Atazanavir Plus Ritonavir or Efavirenz With Abacavir/Lamivudine or Tenofovir/Emtricitabine

Background. We aimed to evaluate treatment responses to atazanavir plus ritonavir (ATV/r) or efavirenz (EFV) in initial antiretroviral regimens among women and men, and determine if treatment outcomes differ by sex

Evaluating Nurse-Physician Communication With a Rubric: A Pilot Study

Poor communication is a leading cause of sentinel events. The aims of this pilot study were to determine whether the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Interprofessional Communication Rubric (IICR) was a reliable tool among nurses and to examine the communication performance of new graduate nurses in a hospital-based simulation center. The IICR demonstrated reliability among raters in this setting (r = .91). The new graduate RNs' communication performance scores were low, warranting continued professional development. The IICR may be used to guide continued education and development for nurse-physician communication. [J Contin Educ Nurs. 2019;50(4):163-169.]

PRIME-nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability

Abstract The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings

Breastfeeding among Latino Families in an Urban Pediatric Office Setting

Objective. To determine the breastfeeding rate of Latino infants at an urban pediatric clinic in the first six months of life and to identify factors associated with breastfeeding. Methods. Investigators conducted a retrospective chart review of infants seen at the clinic in 2014 as part of a mixed methods study. Topics reviewed included demographics, infant health data, and feeding methods at 5 points in time. Bivariate correlations and cross-tabulations explored associations between variables. Results. Most of the mothers (75%) fed their newborns with both breastfeeding and formula (las dos). At 6 months, a majority were formula-fed only (55.9%). Approximately 10% of mothers exclusively breastfed their newborns, and the trend of exclusive breastfeeding remained steady through the 6-month visit. Over time, the number of mothers who exclusively bottle-feed their infants steadily rises. There were no statistical differences among the feeding method groups with regard to birth order of child, number of adults or children in the household, vaccination rate, number of sick visits, or infants’ growth. Conclusions. More targeted attention to this population and other immigrant populations with culturally tailored interventions spanning the prenatal to early infancy periods could increase exclusive breastfeeding and ultimately improve child health