Transforming global leadership skills in graduate nursing programs using an intercultural setting and a case study on refugees.

Transformation of our world to a more just and equitable system will require a fundamental shift from a domination approach to a partnership-based approach. In nursing and health care, this shift will require a global perspective with culturally humble providers and systems. In this article we share the experience of our international course Leadership in Nursing – a Global Approach, a joint project of the University of Iceland Faculty of Nursing and the University of Minnesota School of Nursing. This collaborative immersion course offers a model of global partnership-based health-care education. International partnership-based collaboration in nursing and health-care education prepares students and faculty to take an active role in transforming global systems. Keywords: cultural humility; global leadership; nursing; partnershipPeer reviewe

Coordinated multi-wavelength observations of Sgr A*

We report on recent near-infrared (NIR) and X-ray observations of Sagittarius A* (Sgr A*), the electromagnetic manifestation of the ~4x10^6 solar masses super-massive black hole (SMBH) at the Galactic Center. The goal of these coordinated multi-wavelength observations is to investigate the variable emission from Sgr A* in order to obtain a better understanding of the underlying physical processes in the accretion flow/outflow. The observations have been carried out using the NACO adaptive optics (AO) instrument at the European Southern Observatory's Very Large Telescope (July 2005, May 2007) and the ACIS-I instrument aboard the Chandra X-ray Observatory (July 2005). We report on a polarized NIR flare synchronous to a 8x1033 erg/s X-ray flare in July 2005, and a further flare in May 2007 that shows the highest sub-flare to flare contrast observed until now. The observations can be interpreted in the framework of a model involving a temporary disk with a short jet. In the disk component flux density variations can be explained due to hot spots on relativistic orbits around the central SMBH. The variations of the sub-structures of the May 2007 flare are interpreted as a variation of the hot spot structure due to differential rotation within the disk.Comment: 15 pages, 7 figures, contribution for the conference "The Universe under the Microscope" (AHAR 2008), to be published in Journal of Physics: Conference Series by Institute of Physics Publishin

Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national Irish smoking ban: Interrupted time-series analysis

Copyright @ 2013 Stallings-Smith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Previous studies have shown decreases in cardiovascular mortality following the implementation of comprehensive smoking bans. It is not known whether cerebrovascular or respiratory mortality decreases post-ban. On March 29, 2004, the Republic of Ireland became the first country in the world to implement a national workplace smoking ban. The aim of this study was to assess the effect of this policy on all-cause and cause-specific, non-trauma mortality. Methods: A time-series epidemiologic assessment was conducted, utilizing Poisson regression to examine weekly age and gender-standardized rates for 215,878 non-trauma deaths in the Irish population, ages ≥35 years. The study period was from January 1, 2000, to December 31, 2007, with a post-ban follow-up of 3.75 years. All models were adjusted for time trend, season, influenza, and smoking prevalence. Results: Following ban implementation, an immediate 13% decrease in all-cause mortality (RR: 0.87; 95% CI: 0.76-0.99), a 26% reduction in ischemic heart disease (IHD) (RR: 0.74; 95% CI: 0.63-0.88), a 32% reduction in stroke (RR: 0.68; 95% CI: 0.54-0.85), and a 38% reduction in chronic obstructive pulmonary disease (COPD) (RR: 0.62; 95% CI: 0.46-0.83) mortality was observed. Post-ban reductions in IHD, stroke, and COPD mortalities were seen in ages ≥65 years, but not in ages 35-64 years. COPD mortality reductions were found only in females (RR: 0.47; 95% CI: 0.32-0.70). Post-ban annual trend reductions were not detected for any smoking-related causes of death. Unadjusted estimates indicate that 3,726 (95% CI: 2,305-4,629) smoking-related deaths were likely prevented post-ban. Mortality decreases were primarily due to reductions in passive smoking. Conclusions: The national Irish smoking ban was associated with immediate reductions in early mortality. Importantly, post-ban risk differences did not change with a longer follow-up period. This study corroborates previous evidence for cardiovascular causes, and is the first to demonstrate reductions in cerebrovascular and respiratory causes

A randomized trial to assess the impact of opinion leader endorsed evidence summaries on the use of secondary prevention strategies in patients with coronary artery disease: the ESP-CAD trial protocol [NCT00175240]

BACKGROUND: Although numerous therapies have been shown to be beneficial in the prevention of myocardial infarction and/or death in patients with coronary disease, these therapies are under-used and this gap contributes to sub-optimal patient outcomes. To increase the uptake of proven efficacious therapies in patients with coronary disease, we designed a multifaceted quality improvement intervention employing patient-specific reminders delivered at the point-of-care, with one-page treatment guidelines endorsed by local opinion leaders ("Local Opinion Leader Statement"). This trial is designed to evaluate the impact of these Local Opinion Leader Statements on the practices of primary care physicians caring for patients with coronary disease. In order to isolate the effects of the messenger (the local opinion leader) from the message, we will also test an identical quality improvement intervention that is not signed by a local opinion leader ("Unsigned Evidence Statement") in this trial. METHODS: Randomized trial testing three different interventions in patients with coronary disease: (1) usual care versus (2) Local Opinion Leader Statement versus (3) Unsigned Evidence Statement. Patients diagnosed with coronary artery disease after cardiac catheterization (but without acute coronary syndromes) will be randomly allocated to one of the three interventions by cluster randomization (at the level of their primary care physician), if they are not on optimal statin therapy at baseline. The primary outcome is the proportion of patients demonstrating improvement in their statin management in the first six months post-catheterization. Secondary outcomes include examinations of the use of ACE inhibitors, anti-platelet agents, beta-blockers, non-statin lipid lowering drugs, and provision of smoking cessation advice in the first six months post-catheterization in the three treatment arms. Although randomization will be clustered at the level of the primary care physician, the design effect is anticipated to be negligible and the unit of analysis will be the patient. DISCUSSION: If either the Local Opinion Leader Statement or the Unsigned Evidence Statement improves secondary prevention in patients with coronary disease, they can be easily modified and applied in other communities and for other target conditions

The effects of acute exercise on subsequent cigarette smoking

The present study was conducted to examine the effects of acute aerobic exercise on smoking behavior. On alternate days, 10 healthy young smokers were subjected to half an hour of sustained high exercise (about 56% of maximum work capacity) or of low exercise (about 28% of maximum, simulating normal daytime activity). During the high-exercise condition, there were pronounced increases in physiological markers of physical activity such as mean work, heart rate, and lactic acid as well as elevations in circulating hormones (norepinephrine, epinephrine, and immunoreactive beta-endorphin and cortisol) known to be affected by vigorous exercise. Despite a trend toward decreased desire for cigarettes after the high exercise condition, there were no differences in plasma nicotine levels following the smoking of a usual-brand cigarette 35 min later. The sustained effects of the two exercise conditions were also similar: plasma cotinine levels 24 hr later (reflecting nicotine intake over the entire exercise day) revealed no significant differences between hight and low exercise.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44810/1/10865_2004_Article_BF00846420.pd

Does switching from cigarettes to pipes or cigars reduce tobacco smoke exposure?

Cigarette smoking histories, reported depth of inhalation, number of pipe and cigars (PC) smoked, serum thiocyanate (SCN) and expired air carbon monoxide (CO) levels were examined in PC male smokers enrolled in the Multiple Risk Factor Intervention Trial (MRFIT). Serum SCN levels for all PC smokers were higher than for non-smokers and lower than for current cigarette smokers. Levels were related to the amount of product smoke. Prior cigarette smokers had higher SCN levels when compared to PC users who had never smoked cigarettes, smoked a larger number of tobacco products per day, and reported inhaling into the chest more often. Prospective data on baseline cigarette smokers demonstrated that smokers who stopped all tobacco products had a greater drop in SCN and CO than those who switched to PC. The findings strongly suggest that cessation of all tobacco products is the best strategy for decreasing exposure to tobacco smoke