A study to determine if learning experiences on night duty are meeting the objectives for this experience

Thesis (M.S.)--Boston Universit

Genetic profiling: A legal framework to embrace the challenges

The current issues surrounding the use of genetic profiling technologies in New Zealand are analysed and compared with other jurisdictions, resulting in a number of key recommendations for the legal framework. An amendment to the Human Rights Act, review of the Health Information Privacy Code and an increased role for the Insurance and Savings Ombudsman are discussed in light of the developments in other jurisdictions. The implementation of a genetic database registration system and the development of policies to guide employers, insurers and health professionals on acceptable uses of genetic profile information are presented as recommendations to improve the current approaches. The establishment of an Advisory Body would ensure that safeguards against discrimination continue to be fair and effective, keeping pace with the rapid advancements in this field. The increased availability and the more acceptable costing are making the use of genetic profiling technology attractive. This is contributing further to the legal challenges, particularly when combined with the increasing range of applications for the data provided, in such diverse fields as the insurance industry, employment, personalised pharmaceuticals and the use of genetic databases. It is seen as essential that the legal framework promotes and supports the public in their access and use of genetic profiling technologies. These developments promise to be important and at the forefront of future heath care in New Zealand

Study of Supportive Housing in Illinois: First Interim Report

In particular, the study focuses on the change in service use and the cost of services used by Illinois supportive housing residents 2 years before entering supportive housing and 2 years after. This study will inform policymakers, funders, and others about the importance and cost effectiveness of supportive housing in Illinois

Past approaches and future directions for targeting tumor hypoxia in squamous cell carcinomas of the head and neck

AbstractRecurrent squamous cell carcinoma of the head and neck (SCCHN) carries a poor prognosis. Tumor hypoxia (TH) has been implicated as one of many factors contributing to SCCHN recurrence. TH leads to radiation resistance by reversing radiation-induced DNA damage. Effective strategies to overcome TH may improve outcomes in patients with SCCHN. We searched the English literature on PubMed and reviewed the reference sections of key articles related to TH (publications spanning from the early 1900s to the present). We summarized the underlying theory of TH in SCCHN, methods for quantifying it, and the numerous therapies developed to modulate it. We included articles that set the foundation of TH as a theory and the most relevant articles published within the last 15 years related to TH quantification and therapeutic targeting. Despite extensive research, targeting TH in SCCHN has not become a part of routine clinical practice in North America, and we analyze the pitfalls in hypoxia research that have led to this failure. We propose that future studies should test a combined approach of targeting the immune system in addition to cellular pathways rendered aberrant in TH and should include development of novel surrogate markers of TH and/or TH imaging

Targeting Wnt/β-Catenin Activated Cells with Dominant-Negative N-cadherin to Reduce Neointima Formation

Approximately 50% of coronary artery bypass grafts using the autologous saphenous vein fail within 10 years due to intimal thickening. This study examined whether a gene therapy approach that selectively kills Wnt/β-catenin/T cell factor (TCF) activated vascular smooth muscle cells (VSMCs) using dominant-negative N-cadherin (dn-N-cadherin) reduced intimal thickening. Cultured human VSMCs infected with an adenovirus (Ad) encoding dn-N-cadherin via the TCF promoter (Ad-TOP-dn-N-cadherin) specifically expressed dn-N-cadherin in response to activation of the Wnt/β-catenin/TCF pathway. Infection with Ad-TOP-dn-N-cadherin significantly increased VSMC apoptosis (3 ± 0.2% versus 9 ± 0.7%; p < 0.05, n = 6) and significantly inhibited VSMC migration by 83 ± 15% (p < 0.05, n = 6), but did not affect VSMC proliferation (p > 0.05, n = 5). In an ex vivo human saphenous vein organ culture model, luminal delivery of Ad-TOP-dn-N-cadherin significantly increased VSMC apoptosis after 7 days of culture (4 ± 1.4% versus 9 ± 1.6%; p < 0.01, n = 6) and suppressed intimal thickening by 75 ± 7% (p < 0.05, n = 5), without a detrimental effect on endothelial cell coverage. In vivo, Ad-TOP-dn-N-cadherin significantly reduced intimal thickening at day 21 (n = 10) in comparison to the Ad-β-galactosidase (Ad-β-gal) control virus (n = 12, p < 0.05) in the mouse carotid artery ligation model. In summary, we have developed a novel approach to selectively reduce intimal thickening, which may be beneficial in reducing late vein graft failure

Specialist recommendation for chemoprevention medications in patients at familial risk of breast cancer: a cross-sectional survey in England

In England, the National Institute for Health and Care Excellence guideline for familial breast cancer recommends chemoprevention for women at high and moderate familial risk of breast cancer. However, prescribing of chemoprevention has not improved since the introduction of the guideline in 2013. The study aims to identify the current practice, in England, of familial cancer specialists offering chemoprevention and recommending prescribing in primary care. This was an anonymised national cross-sectional survey of familial breast cancer risk services in England. Lead clinicians were sent an online survey link. The survey questions included whether chemoprevention was offered/considered for high and moderate risk women, when chemoprevention prescribing and recommendation to primary care started, medications prescribed, age groups considered for chemoprevention and existence of a shared prescribing protocol with primary care. The survey was sent to 115 hospital services, responses from 50 services (43%) were included in the analysis. Of the 40 services offering chemoprevention for high risk women, 15 (38%) did not prescribe but 31 (78%) recommended prescribing to primary care. Of the 31 services considering chemoprevention for moderate risk, eight (26%) did not prescribe with 26 (84%) recommended prescribing to primary care. Only three services reported having a shared protocol with primary care. Within three years of the guidelines, many services recognised the role of chemoprevention for both high and moderate risk with a key role for primary care to initiate prescribing. However, there is still room for improvement

Putting knowledge to work in clinical practice : understanding experiences of preceptorship as outcomes of interconnected domains of learning

Aims and objectives: To explore how preceptor support can assist newly qualified nurses to put knowledge to work across interconnected forms of knowledge when delegating to healthcare assistants. Background: Current literature on preceptorship in nursing has failed to explore how competence is underpinned by knowledge frameworks in clinical practice. Design: An ethnographic case study in three hospital sites in England (2011-2014). Methods: Data collection included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis. A tool to assist newly qualified nurses to delegate and supervise newly qualified nurses during the preceptorship period was developed and piloted with thirteen newly qualified nurses in the same sites. A process evaluation was undertaken. Findings: Focusing on a key task for newly qualified nurses, delegation to healthcare assistants, we argue that preceptorship can support newly qualified nurses as they put knowledge to work in the transition from qualifying student to newly qualified nurses. In supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles (interconnected domains of learning) are key to understanding effective preceptorship. Conclusions: We suggest that putting knowledge to work early in their careers with preceptorship support may assist newly qualified nurses to develop confidence and competence in delegation and supervision of healthcare assistants. Relevance to clinical practice: Our findings suggest that newly qualified nurses need to be supported by effective preceptorship in their learning as they transition from undergraduate to post graduate. Preceptorship programmes at ward and organisational level need to recognise the intensity of the learning required during this transition phase

Effect of farm system and milk urea phenotype on milk yield and milk composition of dairy cows in Canterbury

To investigate the effect of farm system, and cow selection for milk urea nitrogen (MUN), on milk yield and milk composition, a farmlet study was carried out between October 2018 and May 2019 in Lincoln, Canterbury. A farm system with a low stocking rate and low N fertiliser input (LSR, 2.9 cows/ha) sown with a conventional ryegrass clover and plantain diverse pastures was compared with a farm system with a moderate stocking rate and moderate N fertiliser (MSR, 3.9 cows/ha) using conventional ryegrass and white clover pastures and supplementing 3 kg DM/cow/d as crushed barley grain. Each farmlet had total herd size of 40 mixed-age HF x J spring-calving dairy cows which included six cows selected solely for a high MUN or a low MUN. There was no effect of farm system on milk fat, protein or lactose content but MUN was lower in LSR compared with MSR. Milk production was also lower for LSR (466 vs 429±12.4 kg MS/cow/ha, P<0.05), owing to poorer quality diet in mid lactation. Cows selected for low MUN tended to produce less milk compared with high MUN cows (4478 vs 3987±174 kg/cow, P<0.10) though this was partially offset by increased protein content in milk of low MUN cows. Farm system and animal selection for MUN have a greater impact on milk yield than on milk composition