Retaining the Next Generation of Nurses: The Wisconsin Nurse Residency Program Provides a Continuum of Support

Because of the high costs associated with new graduate nurse turnover, an academic-service partnership developed a nurse residency program that provides a comprehensive support system that spans 15 months. Now in its fourth year, involving more than 50 urban and rural hospitals of varying sizes and geographic locations, the program provides formalized preceptor training, monthly daylong educational sessions, and mentoring by clinical coaches. Key factors contributing to the success of this program are a dedicated, cohesive planning team of individuals who embrace a common agenda, stakeholder buy-in, appropriate allocation of resources, and clear articulation of measures of success, with associated data collection. Successful elements of the monthly educational sessions are the use of interactive teaching methods, inclusion of content tailored to the unique needs of the nurse residents, and storytelling to facilitate learning from practice. Finally, training to advance the skill development of preceptors, coaches, educators, and facilitators has provided organizations with enduring benefits

Dust Production and Mass Loss in the Galactic Globular Cluster NGC 362

We investigate dust production and stellar mass loss in the Galactic globular cluster NGC 362. Due to its close proximity to the Small Magellanic Cloud (SMC), NGC 362 was imaged with the IRAC and MIPS cameras onboard the Spitzer Space Telescope as part of the Surveying the Agents of Galaxy Evolution (SAGE-SMC) Spitzer Legacy program. We detect several cluster members near the tip of the Red Giant Branch that exhibit infrared excesses indicative of circumstellar dust and find that dust is not present in measurable quantities in stars below the tip of the Red Giant Branch. We modeled the spectral energy distribution (SED) of the stars with the strongest IR excess and find a total cluster dust mass-loss rate of 3.0(+2.0/-1.2) x 10^-9 solar masses per year, corresponding to a gas mass-loss rate of 8.6(+5.6/-3.4) x 10^-6 solar masses per year, assuming [Fe/H] = -1.16. This mass loss is in addition to any dust-less mass loss that is certainly occurring within the cluster. The two most extreme stars, variables V2 and V16, contribute up to 45% of the total cluster dust-traced mass loss. The SEDs of the more moderate stars indicate the presence of silicate dust, as expected for low-mass, low-metallicity stars. Surprisingly, the SED shapes of the stars with the strongest mass-loss rates appear to require the presence of amorphous carbon dust, possibly in combination with silicate dust, despite their oxygen-rich nature. These results corroborate our previous findings in omega Centauri.Comment: 13 pages, 11 figures. Accepted to Ap

Identifying Young Stellar Objects in the Outer Galaxy: l = 224 deg Region in Canis Major

We study a very young star-forming region in the outer Galaxy that is the most concentrated source of outflows in the Spitzer Space Telescope GLIMPSE360 survey. This region, dubbed CMa-l224, is located in the Canis Major OB1 association. CMa-l224 is relatively faint in the mid-infrared, but it shines brightly at the far-infrared wavelengths as revealed by the Herschel Space Observatory data from the Hi-GAL survey. Using the 3.6 and 4.5 $\mu$m data from the Spitzer/GLIMPSE360 survey, combined with the JHK$_s$ 2MASS and the 70-500 $\mu$m Herschel/Hi-GAL data, we develop a young stellar object (YSO) selection criteria based on color-color cuts and fitting of the YSO candidates' spectral energy distributions with YSO 2D radiative transfer models. We identify 293 YSO candidates and estimate physical parameters for 210 sources well-fit with YSO models. We select an additional 47 sources with GLIMPSE360-only photometry as `possible YSO candidates'. The vast majority of these sources are associated with high H$_2$ column density regions and are good targets for follow-up studies. The distribution of YSO candidates at different evolutionary stages with respect to Herschel filaments supports the idea that stars are formed in the filaments and become more dispersed with time. Both the supernova-induced and spontaneous star formation scenarios are plausible in the environmental context of CMa-l224. However, our results indicate that a spontaneous gravitational collapse of filaments is a more likely scenario. The methods developed for CMa-l224 can be used for larger regions in the Galactic plane where the same set of photometry is available.Comment: Accepted for publication in the Astrophysical Journal Supplement Series; 54 pages including appendice

Surveying the Agents of Galaxy Evolution in the Tidally-Stripped, Low Metallicity Small Magellanic Cloud (SAGE-SMC) II. Cool Evolved Stars

We investigate the infrared (IR) properties of cool, evolved stars in the Small Magellanic Cloud (SMC), including the red giant branch (RGB) stars and the dust-producing red supergiant (RSG) and asymptotic giant branch (AGB) stars using observations from the Spitzer Space Telescope Legacy program entitled: "Surveying the Agents of Galaxy Evolution in the Tidally-stripped, Low Metallicity SMC", or SAGE-SMC. The survey includes, for the first time, full spatial coverage of the SMC bar, wing, and tail regions at infrared (IR) wavelengths (3.6 - 160 microns). We identify evolved stars using a combination of near-IR and mid-IR photometry and point out a new feature in the mid-IR color-magnitude diagram that may be due to particularly dusty O-rich AGB stars. We find that the RSG and AGB stars each contribute ~20% of the global SMC flux (extended + point-source) at 3.6 microns, which emphasizes the importance of both stellar types to the integrated flux of distant metal-poor galaxies. The equivalent SAGE survey of the higher-metallicity Large Magellanic Cloud (SAGE-LMC) allows us to explore the influence of metallicity on dust production. We find that the SMC RSG stars are less likely to produce a large amount of dust (as indicated by the [3.6]-[8] color). There is a higher fraction of carbon-rich stars in the SMC, and these stars appear to able to reach colors as red as their LMC counterparts, indicating that C-rich dust forms efficiently in both galaxies. A preliminary estimate of the dust production in AGB and RSG stars reveals that the extreme C-rich AGB stars dominate the dust input in both galaxies, and that the O-rich stars may play a larger role in the LMC than in the SMC.Comment: Accepted for publication in AJ. 25 pages, 36 figures, Table 4 will be available electronically from A

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat