New infant cranium from the African Miocene sheds light on ape evolution

The evolutionary history of extant hominoids (humans and apes) remains poorly understood. The African fossil record during the crucial time period, the Miocene epoch, largely comprises isolated jaws and teeth, and little is known about ape cranial evolution. Here we report on the, to our knowledge, most complete fossil ape cranium yet described, recovered from the 13 million-year-old Middle Miocene site of Napudet, Kenya. The infant specimen, KNM-NP 59050, is assigned to a new species of Nyanzapithecus on the basis of its unerupted permanent teeth, visualized by synchrotron imaging. Its ear canal has a fully ossified tubular ectotympanic, a derived feature linking the species with crown catarrhines. Although it resembles some hylobatids in aspects of its morphology and dental development, it possesses no definitive hylobatid synapomorphies. The combined evidence suggests that nyanzapithecines were stem hominoids close to the origin of extant apes, and that hylobatid-like facial features evolved multiple times during catarrhine evolution

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study

Aim: To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Background: Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager\u27s role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate ‘manager as coach’ training into successful practice outcomes, has remained largely unexplored. Design: A grounded theory study design. Methods: Data, collected between February 2012–May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. Results: The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. Conclusion: The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs

Commencing a nurse education role development journey in a regional Australian health district: results from a mixed method baseline inquiry

Background: Health service-based nurse education roles (NERs) are well positioned to support the integration of theory and practice in Australian nursing. Despite this they are widely viewed as both poorly described and undervalued. Objective: To establish role parameters, typical activity profiles and views and attitudes about their roles, professional practices & linkages, among a sample of regional Australian nurses in NERs. Methods: Design: Participatory action research baseline inquiry. Participants: Nurse educators (NEs) and clinical nurse educators (CNEs) of the Northern New South Wales Local Health District. Mixed method baseline survey (n = 38, 84% response rate) and focus group study (3 groups, n = 33 participants in total). Results: Most survey participants were active in writing education programme material for Registered Nurses (RNs). Two thirds of survey respondents reported responsibility for medical staff training. CNEs were called upon to provide clinical relief (prompted by high patient acuity, sick leave and meal breaks) to the wards and units significantly more frequently than NEs. Activity logging indicated wide-ranging role domain diversity. Providing education and supporting clinical staff were the most prominent role domains for both NEs and CNEs. Dissatisfaction with aspects of NER was high – no role domain attracted higher than 60% overall satisfaction from this representative sample. Most participants were not research-active and many indicated the need for improvements in their linkages to the nursing academy. Focus group discussion suggested a group who were spread thinly, answerable to multiple governance tiers and intellectually under-supported. No consistent guiding educational philosophy was discernible in relation to participants’ own teaching activity. Conclusions: Principle issues related to the diversity of operational and professional responsibility tied to multiple impacting governance structures. Stable and purposeful linkages to nursing faculties/academia were also lacking

Evidence based clinical nursing practice in a regional Australian healthcare setting: predictors of skills and behaviours

Aim: To establish correlates of self-reported skill levels and behaviours in relation to evidence-based practice (EBP) among a representative sample of regional Australian nurses and midwives in senior roles. Background: A survey of regional Australian nurses and midwives indicated that EBP capacity remained low. Job satisfaction, psychological burnout and demographic factors were explored against EBP capacity domains, in order to identify a model which predicted capacity among this group. Method: A quantitative cross-sectional survey which utilised the Developing Evidence Based Practice Questionnaire (DEBPQ) and demographic, job satisfaction and psychological burnout indexes was conducted in early 2012 among senior nurses and midwives of a regional New South Wales Local Health District. Online and hard copy surveys were used and distributed to 405 nurses with 169 returning the survey, representing a response rate of 42%. Stepwise multiple regression procedures were employed to derive predictive models of EBP skill level and behaviour. Results: Three predictive models were obtained. Firstly, higher educational level, lower emotional exhaustion and higher relational job satisfaction were found to be the best predictors of EBP skill level. Secondly, higher extrinsic and relational job satisfaction and higher personal accomplishment were found to be the best predictors of changing practice on the basis of evidence. Thirdly, higher extrinsic and intrinsic job satisfaction and working full time were found to be the best predictors of accessing and reading evidence. Conclusion: Education level and extrinsic job satisfaction are key correlates of EBP capacity in this regional Australian sample. Implications for practice: Nursing workplace policy which promotes and supports the pursuit of post-graduate education and which promotes job satisfaction gain, is likely to result in EBP capacity-related gains among senior nurses and midwives

Dopaminergic Therapy for Motor Symptoms in Early Parkinson Disease Practice Guideline Summary: A Report of the AAN Guideline Subcommittee

Background and Objectives To review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians. Methods A multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Results Initial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety