Multidimensional Factors Affecting Well-Being: A PNI Based Model for Therapeutic Nursing Intervention.

This paper is posted to assist graduate nursing students and others who are interested in my early PNI theory development work. The paper documents development and initial testing of a midrange theory of the effects of various nursing interventions on the psychoneuroimmunological (PNI) network. The hypothesized effects of interventions on various immune factors and subsequent health outcomes are explored, with special interest given to the use of PNI theory in nursing. More traditional nursing theory design principles are imbedded in this theory, including a definition of nursing and nursing intervention, as well as outlining how nurses educated at various levels might use the theory. Examples of how the theory might be tested are also included. This early work was foundational for later studies by myself and others, testing various PNI based propositions. Some of this work is posted on the WKU TopSCHOLAR website as well as published in various professional journals

Planning ahead with children with life-limiting conditions and their families : development, implementation and evaluation of ‘My Choices’

Background: The United Kingdom has led the world in the development of children’s palliative care. Over the past two decades, the illness trajectories of children with life-limiting conditions have extended with new treatments and better home-based care. Future planning is a critically under-researched aspect of children’s palliative care globally. This paper describes the development, implementation and evaluation of innovative child and parent-held palliative care planning resources. The resources were designed to facilitate parent and child thinking and engagement in future planning, and to determine care preferences and preferred locations of care for children with life-limiting conditions from diagnosis onwards. These resources fill a significant gap in palliative care planning before the end-of-life phase. Methods: Drawing on contemporaneous research on producing evidence-based children’s health information, we collaborated with leading children’s not-for-profit organisations, parents, children, and professionals. A set of resources (My Choices booklets) were developed for parents and children and evaluated using interviews (parents, children, professionals) and questionnaires (professionals) and an open web-based consultation. Results: Parents and children responded in three ways: Some used the booklets to produce detailed written plans with clear outcomes and ideas about how best to achieve desired outcomes. Others preferred to use the booklet to help them think about potential options. Remaining parents found it difficult to think about the future and felt there was no point because they perceived there to be no suitable local services. Professionals varied in confidence in their ability to engage with families to plan ahead and identified many challenges that prevented them from doing so. Few families shared their plans with professionals. Parents and children have far stronger preferences for home-care than professionals. Conclusion: The My Choices booklets were revised in light of findings, have been endorsed by Together for Short Lives, and are free to download in English and Welsh for use by parents and young people globally. More work needs to be done to support families who are not yet receptive to planning ahead. Professionals would benefit from more training in person-centred approaches to future planning and additional communications skills to increase confidence and ability to engage with families to deliver sensitive palliative care planning

Nursing Care of the End-Of-Life Patient Twenty Five Years after Passage of the Patient Self-Determination Act

This paper compares the aggressiveness of nursing behavioral intentions in the care of the end-of-life patient between 1989 and 2014. Using a comparison design the effects of patient age, presence of a DNR order and nursing unit norms on the aggressiveness of nursing behavioral intentions were documented in 1989 and again in 2014. The results were compared for significant changes over time. Based on the results of this study, it appears that there has been a significant increase in aggressiveness of nursing behavioral intentions in the care of the end of life patient, even if the patient has a DNR and is attempting to refuse certain nursing or medical procedures. This study has implications for increased teaching on end of life care, quality of life, and rights of patients to self-determination during the end-of-life

Private Plaintiffs\u27 Use of Equitable Remedies Under the RICO Statute: A Means to Reform Corrupted Labor Unions

Part I of this Article outlines the government\u27s approach to civil RICO actions involving labor unions, including an overview of the government\u27s prior civil RICO actions and a summary of the types of issues that often arise in such actions. Part II examines the unique issues involved in a civil RICO action brought by a private plaintiff. The principal issue addressed in this Part is whether a private plaintiff can bring an action under the equitable remedies provisions of the RICO statute. This Part also addresses the issues of how a private plaintiff can gain access to information that may be required to prosecute a civil RICO action and how a private plaintiff could pay for such an action

Nurse Practitioner and Pharmacist Interactions: Implications for Effectiveness of Interdisciplinary Health Care Teams

The Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health,” makes specific recommendations for removing barriers to advanced practice nursing scope of practice. The report also makes important recommendations concerning interdisciplinary teamwork. This article examines the challenges on the professional working relationship between nurse practitioners and pharmacists and provides some insight into the difficulties faced as health care practitioners attempt to work toward the goal of collaborative efforts to advance the care of our patients

Clearance of chikungunya virus infection in lymphoid tissues is promoted by treatment with an agonistic anti-CD137 antibody

CD137, a member of the tumor necrosis factor receptor superfamily of cell surface proteins, acts as a costimulatory receptor on T cells, natural killer cells, B cell subsets, and some dendritic cells. Agonistic anti-CD137 monoclonal antibody (MAb) therapy has been combined with other chemotherapeutic agents in human cancer trials. Based on its ability to promote tumor clearance, we hypothesized that anti-CD137 MAb might activate immune responses and resolve chronic viral infections. We evaluated anti-CD137 MAb therapy in a mouse infection model of chikungunya virus (CHIKV), an alphavirus that causes chronic polyarthritis in humans and is associated with reservoirs of CHIKV RNA that are not cleared efficiently by adaptive immune responses. Analysis of viral tropism revealed that CHIKV RNA was present preferentially in splenic B cells and follicular dendritic cells during the persistent phase of infection, and animals lacking B cells did not develop persistent CHIKV infection in lymphoid tissue. Anti-CD137 MAb treatment resulted in T cell-dependent clearance of CHIKV RNA in lymphoid tissue, although this effect was not observed in musculoskeletal tissue. The clearance of CHIKV RNA from lymphoid tissue by anti-CD137 MAb was associated with reductions in the numbers of germinal center B cells and follicular dendritic cells. Similar results were observed with anti-CD137 MAb treatment of mice infected with Mayaro virus, a related arthritogenic alphavirus. Thus, anti-CD137 MAb treatment promotes resolution of chronic alphavirus infection in lymphoid tissues by reducing the numbers of target cells for infection and persistence

Pauli Exchange Errors in Quantum Computation

In many physically realistic models of quantum computation, Pauli exchange interactions cause a subset of two-qubit errors to occur as a first order effect of couplings within the computer, even in the absence of interactions with the computer's environment. We give an explicit 9-qubit code that corrects both Pauli exchange errors and all one-qubit errors.Comment: Final version accepted for publication in Phys. Rev. Let