An integrative review of leadership competencies and attributes in advanced nursing practice

Aim: To establish what leadership competencies are expected of master level‐edu‐ cated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature. Background: Developments in health care ask for well‐trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed. Design: Integrative review. Methods: Embase, Medline and CINAHL databases were searched (January 2005– December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers. Results: Fifteen studies and seven competency frameworks were included. Synthesis of 150 identified competencies led to a set of 30 core competencies in the clinical, pro‐ fessional, health systems. and health policy leadership domains. Most competencies fitted in one single domain the health policy domain contained the least competencies. Conclusions: This synthesis of 30 core competencies within four leadership domains can be used for further development of evidence‐based curricula on leadership. Next steps include further refining of competencies, addressing gaps, and the linking of knowledge, skills, and attributes. Impact: These findings contribute to leadership development for Advanced Practice Nurses and Clinical Nurse Leaders while aiming at improved health service delivery and guiding of health policies and reforms

The impact of diabetes on the pathogenesis of sepsis

Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones

Increasing Milking Intervals Decreases the Mammary Blood Flow and Mammary Uptake of Nutrients in Dairy Cows

International audienceIncreasing the milking intervals reduces milk yield. The aims of this study were to determine whether the reduction in milk yield could be explained by a decrease in mammary uptake of the nutrients or a decrease in the efficiency of the mammary gland in using the milk precursors to synthesize milk components, or both. In a Latin square design with 5 periods, 4 multiparous lactating dairy cows in midlactation were milked at 8-, 12-, 16-, or 24-h intervals over a period of 7 d. The cows were surgically prepared to estimate the net mammary balance of nutrient precursors of milk components (glucose, alpha-amino nitrogen, acetate, beta-hydroxybutyrate, and total glycerol). The efficiency of the mammary gland in synthesizing milk components was estimated by the mammary uptake:milk output ratio. After 7 d of treatment, the decrease in milk yield of 6.1 kg/d between 8- and 24-h milking intervals was associated with a reduction in the uptake of nutrients by the mammary gland, whereas the efficiency of the mammary gland in synthesizing milk components remained relatively unchanged. The mammary uptake decreased by 26% for glucose, 32% for alpha-amino nitrogen, 18% for acetate, 24% for total glycerol, and 24% for beta-hydroxybutyrate, respectively. These reductions in nutrient uptake were due to a decrease in the mammary blood flow (1.23 +/- 0.24 L/min). For milk fat precursors (acetate, beta-hydroxybutyrate, and total glycerol), the decrease in mammary blood flow explained the entire reduction in the mammary uptake. For glucose and the milk protein precursors, the reduction in the mammary blood flow explained 60% of the decrease in the mammary uptake, with the other 40% being accounted for by a reduction in the mammary extraction of nutrients. The nutrient uptake was altered as milk yield decreased. These decreases began with the 16-h milking interval and were higher at the 24-h milking interval

Longer Milking Intervals Alter Mammary Epithelial Permeability and the Udder's Ability to Extract Nutrients

International audienceIncreasing the milking interval decreases milk yield and modifies milk composition. To gain a clearer understanding of the regulation of milk yield and composition, a study was conducted to establish the response curves of nutrient extraction by the mammary gland and mammary epithelial permeability in response to increasing milking intervals. Four multiparous lactating dairy cows were milked at 8-, 12-, 16-, or 24-h intervals over a period of 7 d using a Latin square design. Between the 8- and 24-h milking intervals, milk yield and milk protein levels fell curvilinearly from 38.2 to 29.2 kg/d and from 1,086 to 827 g/d, respectively. Milk fat yield decreased linearly from 1,475 to 1,235 g/d. Indicators of the opening of tight junctions increased linearly with increasing milking intervals: milk BSA increased from 148 to 207 mg/L and plasma lactose increased from 22.9 to 32.0 mg/L. The mammary gland's ability to extract nutrients decreased with increasing milking intervals. Extraction rates of glucose, beta-hydroxybutyrate, and total glycerol decreased significantly (from 27.2 to 23.3%, from 42.3 to 34.4%, from 36.6 to 30.8% between 8- and 24-h milking intervals, respectively), and not significantly for alpha-amino nitrogen (from 23.2 to 20.0%). The extraction rate of acetate remained constant. Moreover, the extraction of milk fat precursors appeared to be less regulated than those of the precursors of milk protein and lactose, which could partly explain why milk yield and milk protein yield decreased more than milk fat yield. The arteriovenous differences of beta-hydroxybutyrate and total glycerol remained constant, whereas those of glucose decreased significantly from 0.98 to 0.87 +/- 0.05 mmol/L and not significantly from 0.74 to 0.64 +/- 0.12 mmol/L for alpha-amino nitrogen. As a result, the mammary gland's ability to extract nutrients appears to be downregulated explaining partly the decrease in daily milk yield observed in response to increased milking intervals

Isolation and characterization of six microsatellite loci in the larch budmoth Zeiraphera diniana (Lepidoptera: Tortricidae)

Six microsatellite markers were developed for the larch budmoth Zeiraphera diniana Guénée 1845, using two enrichment protocols. The number of alleles ranged from 3 to 15 per locus and observed heterozygosities ranged from 0.09 to 0.98 for the 69 individuals genotyped. Using these markers significant genetic differentiation between one population from Poland and samples from Alpine populations in France and Switzerland (overall FST = 0.0298) was detected. However, the two Alpine samples did not differ significantly. These microsatellite markers are valuable tools for studying the population genetics of Zeiraphera diniana