Psychometric Properties of Standardized Patient and Faculty Rater\u27s Evaluations of Pre-Licensure Nursing Student Competencies

The use of simulation as a teaching modality has been rooted in the military, aviation, space, and engineering for centuries (Bradley, 2006). Clinical simulation allows for training of healthcare providers that might be too costly, risky, or hazardous in the clinical setting (Bradley, 2006). A variety of simulation modalities are used including virtual learning, task trainers, mannequins, and standardized patients (SPs). External demands for improved accountability of clinical performance is requiring nursing educators to reevaluate methods of teaching and how we measure nursing competence (Nehring & Lashley, 2010). Standardized patients have been used in medical school curricula to teach and evaluate clinical competence of medical students for decades (Boulet, 2008). Even though SP programs are used and well-researched in medical schools, the majority of nursing schools have adopted high-fidelity mannequin simulation programs (Sanford, 2010). Standardized patients contribute to increased realism by exposing students to a real patient with opportunities to practice compassionate and empathetic communication skills and receive feedback on how to fine-tune their bedside manner. The capacity to provide compassionate care is the heart and soul of nursing practice as identified by American Association of Colleges of Nursing and the National League of Nursing (Rhodes, Morris, & Lazenby, 2011). SP reliability and validity are well established within medical education, reporting 88-92% agreement on checklists between SPs and faculty. Competency checklists in pre- licensure registered nursing curricula have not been accompanied with equally rigorous psychometric evaluation thus it is unclear whether SP utility in nursing is equivalent to medical education. This study examines the inter-rater reliability and percent agreement of standardized patients and faculty checklist scores when evaluating pre-licensure nursing students. Data analysis of SP and faculty scores found significant agreement (94%-98%) as seen in medical education decades ago. Low internal consistency measures and moderate kappa scores suggest additional research is needed working with multi-site, large sample sizes using the same methodology, cases, and checklists. Nursing programs primarily using mannequins have not been able to realize the potential of using SPs, not only in the evaluation of competence, but also in laying the foundation of practicing and reflecting on humanistic care

Management of Chronic Low Back Pain with a Nonpharmacological Pain Management Kit Among Military Personnel

Background & Purpose:Low back pain is the second leading cause of disability in the United States, affecting 17% of Americans. Chronic low back pain (CLBP) is particularly debilitating among professions such as active duty military personnel (ADMP) who are required to maintain military readiness without the assistance of opioids. This scenario can result in individuals enduring untreated pain or resigning from participation in their unit. The purpose of this project is to determine the effect of providing a nonpharmacological pain management kit (NPMK) on pain and functional ability among ADMP who report CLBP. Study Design:ADMP who suffer from CLBP were enrolled in an evidence-based practice project examining their pain and functioning measured at baseline and after one and four weeks of using the NPMK. Methods:The participants were recruited from Naval Special Warfare. Eligible individuals with CLBP were given the NPMK and instructed how to utilize the five components including BioFreeze, Kinesiology tape, thermal therapy, low back strength and flexibility exercises, and behavioral approaches to complement their pain management routines. Following instruction and then return demonstration of the NPMK components, participants were instructed to use the components of the toolkit each day for the next four weeks. A daily level of pain and compliance with the NPMK was assessed by each subject completing a daily log. Pain was also assessed while each subject completed three functional ability assessments including timed plank, standard dead lift, and sit and reach. Finally, subjects also completed the Patient Specific Functional Scale prior to and at one and four weeks following administration of the NPMK. Results:Eleven subjects were enrolled in the project and maintained a high level of compliance with the NPMK. Findings indicated that participants experienced a reduction in pain and an increase in functional ability over the course of four weeks. Implications for Practice:These findings suggest that use of the NPMK by ADMP can have a beneficial impact on reducing CLBP and increasing functioning. This offers a non-opioid treatment option to manage CLBP

An Autoethnographic Study of Interprofessional Education Partnerships

Background: Thiis qualitative longitudinal study describes an Interprofessional Education (IPE) collaboration between a public university with medical and pharmacy schools and a private, non-affiliated university with a nursing school. The study explores the dynamics of the IPE partnership and lessons learned over a three-year period in which members of the collaborative directed three IPE simulations.Methods and Findings: An autoethnographic inquiry technique was used to interview eight collaborators who designed and implemented a large-scale IPE simulation for approximately 300 students and 100 faculty members annually for three years. Two, 90-minute group narrative interviews were conducted and audio recorded for transcription and analysis. Five themes emerged: Natural Collaboration, Shared Vision and Commitment, Integrations and Synergy, All Hands on Deck, and Lasting Foundations. Collaborators agreed the joint effort was a positive experience with multidimensional returns on investment. They applied teamwork competencies to build the partnership, develop the IPE simulation, and overcome implementation challenges.Conclusions: Thiis article provides readers with the opportunity to learn from those who have been intimately involved in the design and implementation of a large-scale IPE collaboration to enhance the shared learning process for health students and faculty. Findings highlight the complexity of building an IPE collaborative and the necessity to build partnerships with facilitators committed to communication

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Modeling the Costs and Environmental Benefits of Disposal Options for End-of-Life Electronic Equipment: The Case of Used Computer Monitors

Managing the growing quantity of used electronic equipment poses challenges for waste management officials. In this paper, we focus on a large component of the electronic waste stream- computer monitors-and the disposal concerns associated with the lead embodied in cathode ray tubes (CRTs) used in most monitors. We develop a policy simulation model of consumers- disposal options based on the costs of these options and their associated environmental impacts. For the stock of monitors disposed of in the United States in 1998, our preliminary findings suggest that bans on some disposal options would increase disposal costs from about $1 per monitor to between$3 and $20 per monitor. Policies to promote a modest amount of recycling of monitor parts, including lead, can be less expensive. In both cases, the costs of the policies exceed the value of the avoided health effects of CRT disposal

Sialic acid blockade inhibits the metastatic spread of prostate cancer to bone

Background Bone metastasis is a common consequence of advanced prostate cancer. Bisphosphonates can be used to manage symptoms, but there are currently no curative treatments available. Altered tumour cell glycosylation is a hallmark of cancer and is an important driver of a malignant phenotype. In prostate cancer, the sialyltransferase ST6GAL1 is upregulated, and studies show ST6GAL1-mediated aberrant sialylation of N-glycans promotes prostate tumour growth and disease progression. Methods Here, we monitor ST6GAL1 in tumour and serum samples from men with aggressive prostate cancer and using in vitro and in vivo models we investigate the role of ST6GAL1 in prostate cancer bone metastasis. Findings ST6GAL1 is upregulated in patients with prostate cancer with tumours that have spread to the bone and can promote prostate cancer bone metastasis in vivo. The mechanisms involved are multi-faceted and involve modification of the pre-metastatic niche towards bone resorption to promote the vicious cycle, promoting the development of M2 like macrophages, and the regulation of immunosuppressive sialoglycans. Furthermore, using syngeneic mouse models, we show that inhibiting sialylation can block the spread of prostate tumours to bone. Interpretation Our study identifies an important role for ST6GAL1 and α2-6 sialylated N-glycans in prostate cancer bone metastasis, provides proof-of-concept data to show that inhibiting sialylation can suppress the spread of prostate tumours to bone, and highlights sialic acid blockade as an exciting new strategy to develop new therapies for patients with advanced prostate cancer

Sialic acid blockade inhibits the metastatic spread of prostate cancer to bone

Bone metastasis is a common consequence of advanced prostate cancer. Bisphosphonates can be used to manage symptoms, but there are currently no curative treatments available. Altered tumour cell glycosylation is a hallmark of cancer and is an important driver of a malignant phenotype. In prostate cancer, the sialyltransferase ST6GAL1 is upregulated, and studies show ST6GAL1-mediated aberrant sialylation of N-glycans promotes prostate tumour growth and disease progression.Here, we monitor ST6GAL1 in tumour and serum samples from men with aggressive prostate cancer and using in vitro and in vivo models we investigate the role of ST6GAL1 in prostate cancer bone metastasis.ST6GAL1 is upregulated in patients with prostate cancer with tumours that have spread to the bone and can promote prostate cancer bone metastasis in vivo. The mechanisms involved are multi-faceted and involve modification of the pre-metastatic niche towards bone resorption to promote the vicious cycle, promoting the development of M2 like macrophages, and the regulation of immunosuppressive sialoglycans. Furthermore, using syngeneic mouse models, we show that inhibiting sialylation can block the spread of prostate tumours to bone.Our study identifies an important role for ST6GAL1 and α2-6 sialylated N-glycans in prostate cancer bone metastasis, provides proof-of-concept data to show that inhibiting sialylation can suppress the spread of prostate tumours to bone, and highlights sialic acid blockade as an exciting new strategy to develop new therapies for patients with advanced prostate cancer.Prostate Cancer Research and the Mark Foundation For Cancer Research, the Medical Research Council and Prostate Cancer UK. Background Methods Findings Interpretation Funding</p