Orthopedic Nurse Practitioner as a Subspecialty: A Case Study

Purpose: The overall purpose of this study was to describe the ONP role by exploring how and why NPs are utilized in orthopedic health care settings. Two problems associated with the evolving ONP role were addressed: the concomitant decrease in the supply of and increased demand for orthopedic patient care services and the nursing profession’s unmet challenge to keep pace with that increased demand and protection of the public and nursing profession through credentialing of ONPs and programs providing certification and training for ONPs. Approach: This study employed a single-embedded case study research approach to answer the research questions and interpret the results through analysis of interview data, participant observations, and document surveys. Findings and Conclusions: The analysis of the ONP role through the lens of Style’s conceptual model, Nursing as a Social System, and the PEPPA-Plus framework revealed the ONP role lacks the maturity required for long-term sustainability, thereby threatening the viability of the role. Highly specialized knowledge and skill are required for the ONP role and currently the means for supplying adequately trained and/or experienced ONP job applicants is ineffective. The development of the ONP role is contingent upon trusting professional relationships with individuals or groups of orthopedic surgeons, a necessary component of the ONP role. The highly specialized ONP role varies significantly from the general NP role in which it emerged suggesting new methods for training and evaluation may be indicated. Lastly, environmental conditions contribute to the decisions by orthopedic surgeons and health care organizations to employ ONPs. This study identified environmental conditions consistent with those in both Style’s and the PEPPA-Plus models suggesting these models are useful frameworks for ONP-role analysis. Relevance: Findings from this study may influence and inform policy makers to improve and enhance the orthopedic-patient care provided by ONPs and theory development regarding the role and utilization of sub-specialty NPs. This in turn may influence the eventual establishment of evidence-based standards for orthopedic education, training programs, and fellowship accreditation

What the World Needs Now is Love, Sweet Love (Punks)

This article explores the development and creative outcomes of the Yijala Yala Project. This project was created in the Pilbara region as a long-term, inter-generational, multi-platform arts project that set out to highlight cultural heritage as living, continually evolving and in the ‘here and now’ rather than something static. The project name Yijala Yala means ‘now’ in the two main regional languages of Yindjibarndi and Ngarluma. Yijala Yala works with members of the local Aboriginal community to create content that reflects cultural heritage in new ways, and is also created using new methods of teaching and skill-building.Yijala Yala has created content in the following media: films, music, recordings, photographs, books, animation and apps. A major artistic outcome of the project is the beautiful operatic, cross-cultural, multi-media performance work Hipbone Sticking Out, which has played in the Centenary of Canberra Festival and the Melbourne Festival, as well as in Roebourne and Perth

Should Physical Activity Be Included in Nutrition Education? A Comparison of Nutrition Outcomes With and Without In-Class Activities

Limited-resource adults\u27 dietary intakes and nutrition behaviors improve as a result of Expanded Food and Nutrition Education Program (EFNEP)/Supplemental Nutrition Assistance Program Education (SNAP-Ed) participation; however, physical activity education is needed for improved health. The experimental study reported here assessed if spending time doing physical activity education affected dietary impact results and activity among participants. Standard dietary assessments showed no significant differences between groups, and interviews showed greater physical activity improvements/intentions by the experimental group, which suggests that nutrition education can be shortened 15-20 minutes for physical activity demonstrations to improve activity behaviors without adversely affecting nutrition-related behavioral improvements outcomes

Types of Product Innovations and Small Business Performance in Hostile and Benign Environments

The relationship between innovation and performance has been widely studied. In addition, many studies have examined moderating effects of types of competitive environments on this relationship. However, little work has been done to examine how specific types of product innovation strategies are related to performance in hostile and benign environments. Using results from a survey of a sample of small businesses, this paper used regression analysis to examine how degree of change in new product offerings and number of new product lines were related to satisfaction with financial performance. While neither type of innovation was related to satisfaction with performance in benign environments, the number of new lines developed was positively related to satisfaction with financial performance in hostile environments. The results from this sample indicate that the strategy of innovation through development of more new product lines may be preferable to developing dramatic innovations for small businesses in a hostile external environment

Facilitating TILTing as a Faculty Community

In this paper, we describe our perspectives and experiences working as one of several small groups within a campus-wide program at our university to help implement transparency in learning and teaching (TILT) principles. Faculty were asked to implement TILT into lower-and upper-level courses, as well as co-curricular activities, by transforming some aspect of their course or activities to be more transparent, meaning students would be able to better understand its purpose and value and how it relates to their major, future career, and personal lives. The program followed a faculty learning community (FLC) model, where members supported one another through the process and the active participants shared, in addition to a deliverable in the form of a TILTed course element, a written reflection. All participants received monetary compensation for the work completed in the summer, 2021 period. Our group consists of one faculty member from the campus’ TILT Steering Committee serving in the role of facilitator and five faculty members serving in the role of active participants who hold various ranks across five departments within four colleges

Changes to the gut microbiome in young children showing early behavioral signs of autism

The human gut microbiome has increasingly been associated with autism spectrum disorder (ASD), which is a neurological developmental disorder, characterized by impairments to social interaction. The ability of the gut microbiota to signal across the gut-brain-microbiota axis with metabolites, including short-chain fatty acids, impacts brain health and has been identified to play a role in the gastrointestinal and developmental symptoms affecting autistic children. The fecal microbiome of older children with ASD has repeatedly shown particular shifts in the bacterial and fungal microbial community, which are significantly different from age-matched neurotypical controls, but it is still unclear whether these characteristic shifts are detectable before diagnosis. Early microbial colonization patterns can have long-lasting effects on human health, and pre-emptive intervention may be an important mediator to more severe autism. In this study, we characterized both the microbiome and short-chain fatty acid concentrations of fecal samples from young children between 21 and 40 months who were showing early behavioral signs of ASD. The fungal richness and acetic acid concentrations were observed to be higher with increasing autism severity, and the abundance of several bacterial taxa also changed due to the severity of ASD. Bacterial diversity and SCFA concentrations were also associated with stool form, and some bacterial families were found with differential abundance according to stool firmness. An exploratory analysis of the microbiome associated with pre-emptive treatment also showed significant differences at multiple taxonomic levels. These differences may impact the microbial signaling across the gut-brain-microbiota axis and the neurological development of the children

Development and use of an instrument adapted to assess the clinical skills learning environment in the pre-clinical years

BACKGROUND: The Communication, Curriculum, and Culture (C3) instrument is a well-established survey for measuring the professional learning climate or hidden curriculum in the clinical years of medical school. However, few instruments exist for assessing professionalism in the pre-clinical years. We adapted the C3 instrument and assessed its utility during the pre-clinical years at two U.S. medical schools. METHODS: The ten-item Pre-Clinical C3 survey was adapted from the C3 instrument. Surveys were administered at the conclusion of the first and second years of medical school using a repeated cross-sectional design. Factor analysis was performed and Cronbach's alphas were calculated for emerging dimensions. RESULTS: The authors collected 458 and 564 surveys at two medical schools during AY06-07 and AY07-09 years, respectively. Factor analysis of the survey data revealed nine items in three dimensions: "Patients as Objects", "Talking Respectfully of Colleagues", and "Patient-Centered Behaviors". Reliability measures (Cronbach's alpha) for the Pre-Clinical C3 survey data were similar to those of the C3 survey for comparable dimensions for each school. Gender analysis revealed significant differences in all three dimensions. CONCLUSIONS: The Pre-Clinical C3 instrument's performance was similar to the C3 instrument in measuring dimensions of professionalism. As medical education moves toward earlier and more frequent clinical and inter-professional educational experiences, the Pre-Clinical C3 instrument may be especially useful in evaluating the impact of curricular revisions

Metagenomic characterisation of the gut microbiome and effect of complementary feeding on bifidobacterium spp. in Australian infants

Complementary feeding induces dramatic ecological shifts in the infant gut microbiota toward more diverse compositions and functional metabolic capacities, with potential implications for immune and metabolic health. The aim of this study was to examine whether the age at which solid foods are introduced differentially affects the microbiota in predominantly breastfed infants compared with predominantly formula-fed infants. We performed whole-genome shotgun metagenomic sequencing of infant stool samples from a cohort of six-month-old Australian infants enrolled in a nested study within the ORIGINS Project longitudinal birth cohort. Infants born preterm or those who had been administered antibiotics since birth were excluded. The taxonomic composition was highly variable among individuals at this age. Predominantly formula-fed infants exhibited a higher microbiome diversity than predominantly breastfed infants. Among the predominantly breastfed infants, the introduction of solid foods prior to five months of age was associated with higher alpha diversity than solid food introduction after six months of age, primarily due to the loss of Bifidobacterium infantis. In contrast, the age at which solid food was introduced was not associated with the overall change in diversity among predominantly formula-fed infants but was associated with compositional changes in Escherichia abundance. Examining the functional capacity of the microbiota in relation to these changes, we found that the introduction of solid foods after six months of age was associated with elevated one-carbon compound metabolic pathways in both breastfed and formula-fed infants, although the specific metabolic sub-pathways differed, likely reflecting different taxonomic compositions. Our findings suggest that the age of commencement of solid foods influences the gut microbiota composition differently in predominantly breastfed infants than in predominantly formula-fed infants

Evaluating the usefulness of a wordless picture book for adults with intellectual disabilities about the COVID ‐19 vaccination programme using co‐production: The CAREVIS study

© 2024 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Aim: To explore the usefulness of a co‐designed wordless book showing processes of receiving COVID‐19 vaccines designed by, and for, adults with intellectual disabilities. Methods: A qualitative evaluation of the resource using mixed methods. Semi‐structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Results: Understanding the COVID‐19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID‐19 restrictions changing. Conclusion: A visual resource may help conversations about the COVID‐19 vaccine for people with intellectual disabilities.Peer reviewe

World Allergy Organization (WAO) diagnosis and rationale for action against Cow\u27s milk allergy (DRACMA) guidelines update – X – breastfeeding a baby with cow\u27s milk allergy

Cow’s milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow’s milk allergy, it is critical to examine the evidence for and against any form of cow’s milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow’s milk proteins detectable in human milk cause infant cow’s milk allergy symptoms. Current clinical practice recommendations advise a 2–4 week trial of maternal cow’s milk dietary elimination for: a) IgE-mediated cow’s milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow’s milk allergy; and c) infants with moderate to severe eczema/ atopic dermatitis, unresponsive to topical steroids and sensitized to cow’s milk protein. There should be a clear plan for home reintroduction of cow’s milk into the maternal diet for a period of 1 week to determine that the cow’s milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow’s milk reintroduction. The evidence base to support the use of maternal cow’s milk avoidance for the treatment of a breastfed infant with cow’s milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow’s milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow’s milk allergy maternal cow’s milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essentia