Voyage: A Passage Through Orientation

Dedication This DNP project is dedicated to my husband, Jim who carried my school bags to and from the car on every hockey trip, dance competition trip, camping trip, and every other trip, just so I could say I had my homework in case I found time to study. Thank you for making dinners, doing dishes, vacuuming, and providing unwavering support for me through these past years. I also dedicate this project to my children Jacob and Sophia, who always seemed to migrate their way into the dining room late at night for talks when I was up studying. No matter how tired I was back then, I would never trade those precious moments for anything in the world. I love all three of you to the moon and back and could never have done this without your encouragement and love. Acknowledgments This DNP project was not a work completed in a silo, for it took many people to make the Voyage: A passage through orientation a success. I have been so blessed to have leaders like, Rea, Annette, Tom, and Teri that have provided me with ongoing support throughout the years and believed that I could succeed. I am so grateful for their leadership and most of all their friendship. What awesome humans they are. Thank you to the professors at SIUE, who guided me through the DNP process. I want to especially thank Dr. Wendy Hochreiter who took me on and got me back on the DNP track. Without her guidance and expert knowledge, I know for sure I would not have continued a course for my DNP. She has been my faithful and patient advisor and I am so thankful to have taken this voyage with her. The unit educators, past and present, were the ones who made the Voyage orientation model a success. Without Jocelyn Wyms, Cheryle Phillips, Katelyn Bartels, Jacqueline Curtis, Tiffany Cornelius, and Angel Wilson writing the competencies for their units, the Voyage would not have come to fruition. Without the dedication of Jocelyn’s, Tiffany’s, Katelyn’s, Angel’s, and Stacey’s desire to improve the on-boarding process for new graduate nurses, the Voyage model would not have become the standard of practice for orientation. They endured a pandemic and rolled out the Voyage all at the same time. Collaborating with this group of professionals has been so enjoyable and most inspiring to me. I am forever grateful to them. My CTD family has been so supportive throughout this process. Angela, Lisa, Donna, Jeremy, MaryAnn and now Stacey, have been my rocks through the challenges and successes of my DNP journey. Their listening ears and constructive feedback has been invaluable. I cannot thank each of them enough for always being there for me. A special thanks to MaryAnn, my mentor, who while on her own PhD journey, still found time to assist me when I asked for her expertise. A special thanks to Jeremy for standing with me through the Covid-19 summer of 2020. Your presence in our vacant office, made the lonely times more bearable. Lisa and Jeremy, your DNP journey will also end this year. I am so very proud of what you are accomplishing. Lastly, I want to thank my family and my extended family of friends. You know who you are, and you know that I could never be successful without your steadfast support. Whether you just listened, or you were just there, your love and friendship was what made me stay strong in my pursuit of my DNP. Thanks so much to all of you for being there for me every time, all the time. A special thank you to Zandra who told me we had to start our DNP together. It was wonderful having you there in classes and you there to validate my DNP woes. Though I took a little longer than you to finish, we persisted and we did it! We are Doctors in Nursing now! To Julie, my BFF, words are not enough to tell you what it means to have someone like you love me always and forever. And to my parents, who without their solid foundation given to me at the beginning of life, this DNP would not have happened. They instilled in me that learning is a lifetime event, not a onetime event. Thanks again to everyone who has been on this DNP voyage with me. The waters may have been rough at times, but the beauty of accomplishment, made the rough waters calm again. Abstract In the summer of 2020, 21 new graduate nurses (NGN) began their orientation at a community hospital in the St. Louis metropolitan area. It was at the height of the COVID-19 pandemic. The transition from an academic environment to a hospital environment was stressful enough for an NGN without a pandemic. It was imperative that a structured orientation plan be implemented to promote a smooth transition into professional practice in a hospital setting for the NGN. A tiered skills acquisition model (TSAM) was developed and entitled, Voyage: A passage through orientation, which incorporated a married state between the NGN and preceptor. Though the Voyage TSAM was initiated during a pandemic, the model was accepted and valued as the standard of practice for NGN orientation. After completing orientation, the NGNs were still overwhelmed, but with the Voyage, the NGNs were better organized, confident, and more prepared to care for patients independently

A Transcriptome-Wide Association Study Identifies Novel Candidate Susceptibility Genes for Pancreatic Cancer

International audienceBACKGROUND: Although 20 pancreatic cancer susceptibility loci have been identified through genome-wide association studies in individuals of European ancestry, much of its heritability remains unexplained and the genes responsible largely unknown. METHODS: To discover novel pancreatic cancer risk loci and possible causal genes, we performed a pancreatic cancer transcriptome-wide association study in Europeans using three approaches: FUSION, MetaXcan, and Summary-MulTiXcan. We integrated genome-wide association studies summary statistics from 9040 pancreatic cancer cases and 12 496 controls, with gene expression prediction models built using transcriptome data from histologically normal pancreatic tissue samples (NCI Laboratory of Translational Genomics [n = 95] and Genotype-Tissue Expression v7 [n = 174] datasets) and data from 48 different tissues (Genotype-Tissue Expression v7, n = 74-421 samples). RESULTS: We identified 25 genes whose genetically predicted expression was statistically significantly associated with pancreatic cancer risk (false discovery rate < .05), including 14 candidate genes at 11 novel loci (1p36.12: CELA3B; 9q31.1: SMC2, SMC2-AS1; 10q23.31: RP11-80H5.9; 12q13.13: SMUG1; 14q32.33: BTBD6; 15q23: HEXA; 15q26.1: RCCD1; 17q12: PNMT, CDK12, PGAP3; 17q22: SUPT4H1; 18q11.22: RP11-888D10.3; and 19p13.11: PGPEP1) and 11 at six known risk loci (5p15.33: TERT, CLPTM1L, ZDHHC11B; 7p14.1: INHBA; 9q34.2: ABO; 13q12.2: PDX1; 13q22.1: KLF5; and 16q23.1: WDR59, CFDP1, BCAR1, TMEM170A). The association for 12 of these genes (CELA3B, SMC2, and PNMT at novel risk loci and TERT, CLPTM1L, INHBA, ABO, PDX1, KLF5, WDR59, CFDP1, and BCAR1 at known loci) remained statistically significant after Bonferroni correction. CONCLUSIONS: By integrating gene expression and genotype data, we identified novel pancreatic cancer risk loci and candidate functional genes that warrant further investigation. Published by Oxford University Press 2020. This work is written by US Government employees and is in the public domain in the

A genome-wide association study identifies pancreatic cancer susceptibility loci on chromosomes 13q22.1, 1q32.1 and 5p15.33.

We conducted a genome-wide association study (GWAS) of pancreatic cancer in 3,851 cases and 3,934 controls drawn from twelve prospective cohort studies and eight case-control studies. Based on a logistic regression model for genotype trend effect that was adjusted for study, age, sex, self-described ancestry and five principal components, we identified eight SNPs that map to three loci on chromosomes 13q22.1, 1q32.1 and 5p15.33. Two correlated SNPs, rs9543325 (P=3.27×10(−11); per allele odds ratio, OR 1.26, 95% CI=1.18-1.35) and rs9564966 (P=5.86×10(−8); per allele OR 1.21, 95% CI=1.13-1.30) map to a non-genic region on chromosome 13q22.1. Five SNPs on 1q32.1 map to NR5A2; the strongest signal was rs3790844 (P=2.45×10(−10); per allele OR 0.77, 95% CI=0.71-0.84). A single SNP, rs401681 (P=3.66×10(−7); per allele OR 1.19, 95% CI=1.11-1.27) maps to the CLPTM1L-TERT locus on 5p15.33, associated with multiple cancers. Our study has identified common susceptibility loci for pancreatic cancer that warrant follow-up studies