Evaluation of the Impact of a Nurse Practitioner (NP) Residency Program on a Selected New NP Graduate in an Outpatient Clinic in Massachusetts

Background: As the role of nurse practitioners (NPs) evolves and educational approaches to training NPs are modified to accommodate these changes, a gap in adequate training for many newly graduated nurse practitioners exists. Additional post-graduate supervised training is needed to ensure confidence and competence of new providers. Such programs are not currently available at small, outpatient settings in the United States. Purpose: The purpose of this Quality Improvement (QI) DNP project was to evaluate the impact of a newlylaunched primary care nurse practitioner residency program on a selected new NP graduate (hereafter called the ‘resident’) at an independent, outpatient, primary care office. Methods: This DNP student incorporated a QI framework with an educational evaluation design, using a Likert-scale questionnaire. Benner’s novice-to-expert framework and the impostor phenomenon often experienced during this transition as originally outlined by Clance and Imes were used to examine the results. The questionnaire was administered to the resident at 3- and 6- month intervals. Informal discussions and journaling were also evaluated to construct a qualitative evaluation of the resident’s experience. Results/Discussion: The questionnaire and qualitative discussions/journaling results revealed that the new resident expressed and exhibited an increase in confidence and competence over time during the first 6 months of the newly launched NP residency program. The resident, ultimately, also reported increased satisfaction in her role as she progressed through Benner’s framework, despite experiencing the impostor phenomenon. The residency was developed for a specific primary care practice site which received no outside funding, yet the practice yielded a net positive financial return on investment (ROI) at the 6-month mark of the program. These results reflect the efficacy of such a program for new NPs

Algal Growth Response to Nutrient Loading on the Lower Boise River, Idaho

Nitrate and phosphate concentrations in the Lower Boise River become increasingly elevated with distance downstream. While there is correlative evidence that there is algal growth from elevated nutrients, no one has formally evaluated the algal growth response from nutrient loading. We quantified algal biomass in response to increased nutrient concentrations by sampling benthic algal biomass from natural substrata (rocks) and artificial substrata that also assessed nutrient limitation along a 64 mile reach from near Diversion Dam to the city of Parma that exhibited an increase of nitrate (0.01 mg/L to 3.40 mg/L) and phosphate (below detection to 0.56 mg/L). Samples were collected from August to October of 2013. We observed low values for algal biomass accrual rate on the unamended artificial substrata in the upper section of the Boise (above Lander Street, Mile 12) of 1.41 – 1.60 mg chlorophyll a/m2/day, accrual rate values increased to 7.03 – 9.88 mg chlorophyll a/m2/day near Caldwell (Mile 41), then declined to 6.42 mg chlorophyll a/m2/day at the confluence with the Snake River. Trends in nutrient limitation were similar for both August and October, showing lack of algal biomass response to nutrient additions (nutrient limitation) downstream of the Lander wastewater treatment plant discharge (Mile 12). This observation corresponds to higher algal biomass growth downstream. The increased algal biomass growth in the lower Boise is interpreted to be in response to nutrient loading, primarily from wastewater discharge. In the lowermost portion of the Boise River (below Mile 55) a decline in algal biomass is observed, presumably due to light limitation by turbid water in the lower portion of the river. Reductions in nutrients in this section of the river may not reduce algal biomass. Above Lander wastewater treatment plant (Mile 12), nitrate limitation is observed. This suggests that declines in phosphorus loading alone in the lower Boise River may not reduce algal biomass levels to those observed above the Lander wastewater treatment plant

Bacterial mechanosensitive channels : progress towards an understanding of their roles in cell physiology

Open Access funded by Wellcome Trust Under a Creative Commons license Thanks to all members of the Aberdeen group, collaborators and friends whose discussions have spurred the development of the MS channel field. Special thanks to Doug Rees, Diane Newman and Rob Phillips for their support and hospitality at Caltech. Unique insights have been provided by members of the Newman and Phillips research groups, particularly, Caj Neubauer, Gargi Kulkarni and Megan Bergkessel, Heun Jin Lee and Maja Bialecka-Fornal. The author's research on MS channels is supported by a grant from The Wellcome Trust (WT092552MA) and the BBSRC (BB/H017917/1). The author is a Leverhulme Emeritus Fellow and this work was supported in part by a CEMI Visiting Faculty Fellowship from Caltech.Peer reviewedPublisher PD

Titania-doped tantala/silica coatings for gravitational-wave detection

Reducing thermal noise from optical coatings is crucial to reaching the required sensitivity in next generation interferometric gravitational-wave detectors. Here we show that adding TiO2 to Ta2O5 in Ta2O5/SiO2 coatings reduces the internal friction and in addition present data confirming it reduces thermal noise. We also show that TiO2-doped Ta2O5/SiO2 coatings are close to satisfying the optical absorption requirements of second generation gravitational-wave detectors

Developing and applying heterogeneous phylogenetic models with XRate

Modeling sequence evolution on phylogenetic trees is a useful technique in computational biology. Especially powerful are models which take account of the heterogeneous nature of sequence evolution according to the "grammar" of the encoded gene features. However, beyond a modest level of model complexity, manual coding of models becomes prohibitively labor-intensive. We demonstrate, via a set of case studies, the new built-in model-prototyping capabilities of XRate (macros and Scheme extensions). These features allow rapid implementation of phylogenetic models which would have previously been far more labor-intensive. XRate's new capabilities for lineage-specific models, ancestral sequence reconstruction, and improved annotation output are also discussed. XRate's flexible model-specification capabilities and computational efficiency make it well-suited to developing and prototyping phylogenetic grammar models. XRate is available as part of the DART software package: http://biowiki.org/DART .Comment: 34 pages, 3 figures, glossary of XRate model terminolog

Mirror coating solution for the cryogenic Einstein telescope

Planned, cryogenic gravitational-wave detectors will require improved coatings with a strain thermal noise reduced by a factor of 25 compared to Advanced LIGO. In this article, we present investigations of HfO2 doped with SiO2 as a new coating material for future detectors. Our measurements show an extinction coefficient of k=6×10−6 and a mechanical loss of ϕ=3.8×10−4 at 10,K, which is a factor of 2 below that of SiO2, the currently used low refractive-index coating material. These properties make HfO2 doped with SiO2 ideally suited as a low-index partner material for use with a-Si in the lower part of a multimaterial coating. Based on these results we present a multimaterial coating design which, for the first time, can simultaneously meet the strict requirements on optical absorption and thermal noise of the cryogenic Einstein Telescope

First international new intravascular rigid-flex endovascular stent study (FINESS): Clinical and angiographic results after elective and urgent stent implantation

Objectives. The purpose of this study was to determine the feasibility, safety and efficacy of elective and urgent deployment of the new intravascular rigid-flex (NIR) stent in patients with coronary artery disease. Background. Stent implantation has been shown to be effective in the treatment of focal, new coronary stenoses and in restoring coronary flow after coronary dissection and abrupt vessel closure. However, currently available stents either lack flexibility, hindering navigation through tortuous arteries, or lack axial strength, resulting in suboptimal scaffolding of the vessel. The unique transforming multicellular design of the NIR stent appears to provide both longitudinal flexibility and radial strength. Methods. NIR stent implantation was attempted in 255 patients (341 lesions) enrolled prospectively in a multicenter international registry from December 1995 through March 1996. Nine-, 16- and 32-mm long NIR stents were manually crimped onto coronary balloons and deployed in native coronary (94%) and saphenous vein graft (6%) lesions. Seventy-four percent of patients underwent elective stenting for primary or restenotic lesions, 21% for a suboptimal angioplasty result and 5% for threatened or abrupt vessel closure. Fifty-two percent of patients presented with unstable angina, 48% had a previous myocardial infarction, and 45% had multivessel disease. Coronary lesions were frequently complex, occurring in relatively small arteries (mean [±SD] reference diameter 2.8 ± 0.6 mm). Patients were followed up for 6 months for the occurrence of major adverse cardiovascular events. Results. Stent deployment was accomplished in 98% of lesions. Mean minimal lumen diameter increased by 1.51 ± 0.51 mm (from 1.09 ± 0.43 mm before to 2.60 ± 0.50 mm after the procedure). Mean percent diameter stenosis decreased from 61 ± 13% before to 17 ± 7% after intervention. A successful interventional procedure with <50% diameter stenosis of all treatment site lesions and no major adverse cardiac events within 30 days occurred in 95% of patients. Event-free survival at 6 months was 82%. Ninety-four percent of surviving patients were either asymptomatic or had mild stable angina at 6 month follow-up. Conclusions. Despite unfavorable clinical and angiographic characteristics of the majority of patients enrolled, the acute angiographic results and early clinical outcome after NIR stent deployment were very promising. A prospective, randomized trial comparing the NIR stent with other currently available stents appears warranted

Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

BACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the relative merits of either technique in treatment of unstable angina. Methods and Results- Seven hundred fifty-five patients with stable angina were randomly assigned to coronary stenting (374) or bypass surgery (381), and 450 patients with unstable angina were randomly assigned to coronary stenting (226) or bypass surgery (224). All patients had multivessel disease considered to be equally treatable by either technique. Freedom from major adverse events, including death, myocardial infarction, and cerebrovascular events, at 1 year was not different in unstable patients (91.2% versus 88.9%) and stable patients (90.4% versus 92.6%) treated, respectively, with coronary stenting or bypass surgery. Freedom from repeat revascularization at 1 year was similar in unstable and stable angina treated with stenting (79.2% versus 78.9%) or bypass surgery (96.3% versus 96%) but was significantly higher in both unstable and stable patients treated with stenting (16.8% versus 16.9%) compared with bypass surgery (3.6% versus 3.5%). Neither the difference in costs between stented or bypassed stable or unstable angina ($2594 versus$3627) nor the cost-effectiveness was significantly different at 1 year. CONCLUSIONS: There was no difference in rates of death, myocardial infarction, and cerebrovascular event at 1 year in patients with unstable angina and multivessel disease treated with either stented angioplasty or bypass surgery compared with patients with stable angina. The rate of repeat revascularization of both unstable and stable angina was significantly higher in patients with stents