An Essential Perspective of Surgery: a Family Nurse Practitioner Clinical Care Model

Family Nurse Practitioners provide efficient, cost effective and safe care to patients in a variety of healthcare settings. Through the implementation of a clinical care practice model, the role of the Family Nurse Practitioner is a part of the multidisciplinary team caring for the outpatient surgical population. Patient satisfaction, system and patient benefits, including potential for increased revenue and effects on continuity of care across the spectrum of the surgical journey will be evaluated. This scholarly project examines the evidence in the form of literature review, conceptual and theoretical frameworks to evaluate the 1:1 clinical care model utilizing a Family Nurse Practitioners as part of the multidisciplinary team in the care of the outpatient surgical patient. The model was presented to a group of perioperative professionals belonging to the Association of periOperative Registered Nurses (AORN). Feedback in the form of a guided discussion and notecards provided networking opportunities, grey literature ideas, and further ideas for implementation locations. The eight Essentials of Doctoral Education for Advanced Practice Nursing were accomplished through completion of the project

Using administrative data to monitor racial/ethnic disparities and disproportionality within child welfare agencies: process and preliminary outcomes

Child welfare administrative data are increasingly used to identify racial/ethnic disproportionality and disparities at various levels of aggregation. However, child welfare agencies typically face challenges in harnessing administrative data to examine racial/ethnic disproportionality and disparities at meaningful levels of analysis due to limited resources and/or tools for reporting. This article describes the process through which a multi-state workgroup designed and developed management reports to monitor racial/ethnic disparities and disproportionality using a web-based child welfare administrative data reporting system. The article provides an overview of the process, outcome, and challenges of the group’s work with the goal of offering a starting point for discussion to others who may be seeking to monitor racial/ethnic disparities and disproportionality, regardless of their reporting system

Genome-wide oxidative bisulfite sequencing identifies sex-specific methylation differences in the human placenta.

DNA methylation is an important regulator of gene function. Fetal sex is associated with the risk of several specific pregnancy complications related to placental function. However, the association between fetal sex and placental DNA methylation remains poorly understood. We carried out whole-genome oxidative bisulfite sequencing in the placentas of two healthy female and two healthy male pregnancies generating an average genome depth of coverage of 25x. Most highly ranked differentially methylated regions (DMRs) were located on the X chromosome but we identified a 225 kb sex-specific DMR in the body of the CUB and Sushi Multiple Domains 1 (CSMD1) gene on chromosome 8. The sex-specific differential methylation pattern observed in this region was validated in additional placentas using in-solution target capture. In a new RNA-seq data set from 64 female and 67 male placentas, CSMD1 mRNA was 1.8-fold higher in male than in female placentas (P value = 8.5 × 10-7, Mann-Whitney test). Exon-level quantification of CSMD1 mRNA from these 131 placentas suggested a likely placenta-specific CSMD1 isoform not detected in the 21 somatic tissues analyzed. We show that the gene body of an autosomal gene, CSMD1, is differentially methylated in a sex- and placental-specific manner, displaying sex-specific differences in placental transcript abundance

Healthcare providers versus patients\u27 understanding of health beliefs and values

This study examined how well healthcare providers perceive and understand their patients’ health beliefs and values compared to patients’ actual beliefs, and to determine if communication relationships maybe improved as a result of healthcare providers’ understanding of their patients’ illness from their perspective. A total of 61 participants (7 healthcare providers and 54 patients) were enrolled in the study. Healthcare providers and patients individually completed survey instruments and each participated in a structured focus group. Healthcare provider and patient differences revealed that patients perceived greater meaning of their illness (p = 0.038), and a greater preference for partnership (p = 0.026) compared to providers. The three qualitative themes most important for understanding patients’ health beliefs and values as perceived by healthcare providers were education, trust, and culture. Educating patients was perceived as having the greatest impact and also the easiest method to implement to foster providers’ understanding, with at least one patient focus group in agreement of same. Likewise, three themes were derived from patients’ perspectives as relatively more important in understanding providers’ beliefs and values; bidirectional communication, comprehensive treatment, and discipline. Overwhelmingly, bidirectional communication was perceived as a critical factor as having the greatest impact and may also be easiest to implement according to these patients. When patients and healthcare providers listen and communicate with each other, they are likely to develop a shared understanding that may improve future decision making and quality of care patients receive

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Posture and Locomotion Coupling: A Target for Rehabilitation Interventions in Persons with Parkinson's Disease

Disorders of posture, balance, and gait are debilitating motor manifestations of advancing Parkinson's disease requiring rehabilitation intervention. These problems often reflect difficulties with coupling or sequencing posture and locomotion during complex whole body movements linked with falls. Considerable progress has been made with demonstrating the effectiveness of exercise interventions for individuals with Parkinson's disease. However, gaps remain in the evidence base for specific interventions and the optimal content of exercise interventions. Using a conceptual theoretical framework and experimental findings, this perspective and review advances the viewpoint that rehabilitation interventions focused on separate or isolated components of posture, balance, or gait may limit the effectiveness of current clinical practices. It is argued that treatment effectiveness may be improved by directly targeting posture and locomotion coupling problems as causal factors contributing to balance and gait dysfunction. This approach may help advance current clinical practice and improve outcomes in rehabilitation for persons with Parkinson's disease

Chemical Reaction Dynamics at Surfaces

Contains reports on three research projects.Joint Services Electronics Program (Contract DAAL03-86-K-0002)Joint Services Electronics Program (Contract DAAL03-89-C-0001)National Science Foundation (Grant CHE 85-08734)MIT Energy Laboratory - Synthetic Fuels CenterPetroleum Research Fund (Contract 19014-AC5

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Effects of Smart Position Only (SPOT) Tag Deployment on White Sharks Carcharodon carcharias in South Africa

We present 15 individual cases of sub-adult white sharks that were SPOT tagged in South Africa from 2003–2004 and have been re-sighted as recently as 2011. Our observations suggest SPOT tags can cause permanent cosmetic and structural damage to white shark dorsal fins depending on the duration of tag attachment. SPOT tags that detached within 12–24 months did not cause long term damage to the dorsal fin other than pigmentation scarring. Within 12 months of deployment, tag fouling can occur. After 24 months of deployment permanent damage to the dorsal fin occurred. A shark survived this prolonged attachment and there seems little compromise on the animal's long term survival and resultant body growth. This is the first investigation detailing the long term effects of SPOT deployment on the dorsal fin of white sharks