Nurse Practitioner\u27S Beliefs Regarding Controlled Substance Prescriptive Priviledges

Prescriptive authority for controlled substances for advanced practice nurses has been a very controversial topic over the past years and continues to be an issue today. Research has shown that nurse practitioners prescribe medications appropriately but that barriers to nurse practitioner’s prescribing practices remain even th o u ^ legal authority has been granted. This descriptive study sought to describe the beliefs of nurse practitioners in the state of Mississippi concerning prescriptive privileges of controlled substances. Erickson, Tomlin, and Swain’s Theory of Modeling and Role-modeling (1983) provided the conceptual framework for this study. The research question asked in this study was as follows; What are the beliefs of nurse practitioners regarding controlled substance prescriptive privileges? A convenience sample of 80 nurse practitioners (Family, Adult, Gerontological, Pediatric, and Ob-Gyn) registered with the Mississippi Board of Nursing were surveyed using the Robertson’s Prescriptive Privilege Survey (RPPS). Responses to the instrument were analyzed using descriptive statistics including frequencies and percentages. Answers to open-ended questions were subjected to content analysis. While 60% of those surveyed would like to have some controlled substance privileges, a majority of nurse practitioners desired to continue to practice with some constraints regarding controlled substances. Nurse practitioners who do not wish to have the privilege to prescribe controlled substances cited issues of liability, responsibility, and competency as reasons not to prescribe. If nurse practitioners did have prescribing privileges, they would utilize them primarily to manage pain, cough, and anxiety for Schedules III, IV, or V Nurse practitioners believed that the inconvenience of not having controlled substance prescribing privileges was mitigated by collaborative physicians’ willingness to prescribe needed schedule drugs. Further research is recommended toexamine the prescribing practices of nurse practitioners in states with controlled substance prescriptive rights and to explore the attitudes and beliefs of physicians regarding controlled substance prescritive rights for nurse practitioners

Transgenic mouse models of childhood-onset psychiatric disorders

Available in PMC 2012 April 1.Childhood-onset psychiatric disorders, such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), mood disorders, obsessive compulsive spectrum disorders (OCSD), and schizophrenia (SZ), affect many school-age children, leading to a lower quality of life, including difficulties in school and personal relationships that persist into adulthood. Currently, the causes of these psychiatric disorders are poorly understood, resulting in difficulty diagnosing affected children, and insufficient treatment options. Family and twin studies implicate a genetic contribution for ADHD, ASD, mood disorders, OCSD, and SZ. Identification of candidate genes and chromosomal regions associated with a particular disorder provide targets for directed research, and understanding how these genes influence the disease state will provide valuable insights for improving the diagnosis and treatment of children with psychiatric disorders. Transgenic mouse models are one important approach in the study of human diseases, allowing for the use of a variety of experimental approaches to dissect the contribution of a specific chromosomal or genetic abnormality in human disorders. While it is impossible to model an entire psychiatric disorder in a single mouse model, these models can be extremely valuable in dissecting out the specific role of a gene, pathway, neuron subtype, or brain region in a particular abnormal behavior. In this review we discuss existing transgenic mouse models for childhood-onset psychiatric disorders. We compare the strength and weakness of various transgenic mouse models proposed for each of the common childhood-onset psychiatric disorders, and discuss future directions for the study of these disorders using cutting-edge genetic tools.National Institutes of Health (U.S.) (postdoctoral training program fellowship)National Institute of Mental Health (U.S.)Hartwell FoundationSimons FoundationMcKnight FoundationDuke Institute for Brain Science

Intraseasonal Variations in Tropical Energy Balance: Relevance to Climate Sensitivity?

Intraseasonal variability of deep convection represents a fundamental mode of organization for tropical convection. While most studies of intraseasonal oscillations (ISOs) have focused on the spatial propagation and dynamics of convectively coupled circulations, here we examine the projection of ISOs on the tropically-averaged heat and moisture budget. One unresolved question concerns the degree to which observable variations in the "fast" processes (e.g. convection, radiative / turbulent fluxes) can inform our understanding of feedback mechanisms operable in the context of climate change. Our analysis use daily data from satellite observations, the Modern Era analysis for Research and Applications (MERRA), and other model integrations to address these questions: (i) How are tropospheric temperature variations related to that tropical deep convection and the associated ice cloud fractional amount (ICF), ice water path (IWP), and properties of warmer liquid clouds? (ii) What role does moisture transport play vis-a-vis ocean latent heat flux in enabling the evolution of deep convection to mediate PBL - free atmospheric temperature equilibration? (iii) What affect do convectively generated upper-tropospheric clouds have on the TOA radiation budget? Our methodology is similar to that of Spencer et al., (2007 GRL ) whereby a composite time series of various quantities over 60+ ISO events is built using tropical mean tropospheric temperature signal as a reference to which the variables are related at various lag times (from -30 to +30 days). The area of interest encompasses the global oceans between 20oN/S. The increase of convective precipitation cannot be sustained by evaporation within the domain, implying strong moisture transports into the tropical ocean area. The decrease in net TOA radiation that develops after the peak in deep convective rainfall, is part of the response that constitutes a "discharge" / "recharge" mechanism that facilitates tropical heat balance maintenance on these time scales. However, water vapor and hydrologic scaling relationships for this mode of variability cast doubt on the utility of ISO variations as proxies for climate sensitivity response to external radiatively forced (e.g. greenhouse gas-induced) climate change

NRF2 and the Ambiguous Consequences of Its Activation during Initiation and the Subsequent Stages of Tumourigenesis

NF-E2 p45-related factor 2 (NRF2, encoded in the human by NFE2L2) mediates short-term adaptation to thiol-reactive stressors. In normal cells, activation of NRF2 by a thiol-reactive stressor helps prevent, for a limited period of time, the initiation of cancer by chemical carcinogens through induction of genes encoding drug-metabolising enzymes. However, in many tumour types, NRF2 is permanently upregulated. In such cases, its overexpressed target genes support the promotion and progression of cancer by suppressing oxidative stress, because they constitutively increase the capacity to scavenge reactive oxygen species (ROS), and they support cell proliferation by increasing ribonucleotide synthesis, serine biosynthesis and autophagy. Herein, we describe cancer chemoprevention and the discovery of the essential role played by NRF2 in orchestrating protection against chemical carcinogenesis. We similarly describe the discoveries of somatic mutations in NFE2L2 and the gene encoding the principal NRF2 repressor, Kelch-like ECH-associated protein 1 (KEAP1) along with that encoding a component of the E3 ubiquitin-ligase complex Cullin 3 (CUL3), which result in permanent activation of NRF2, and the recognition that such mutations occur frequently in many types of cancer. Notably, mutations in NFE2L2, KEAP1 and CUL3 that cause persistent upregulation of NRF2 often co-exist with mutations that activate KRAS and the PI3K-PKB/Akt pathway, suggesting NRF2 supports growth of tumours in which KRAS or PKB/Akt are hyperactive. Besides somatic mutations, NRF2 activation in human tumours can occur by other means, such as alternative splicing that results in a NRF2 protein which lacks the KEAP1-binding domain or overexpression of other KEAP1-binding partners that compete with NRF2. Lastly, as NRF2 upregulation is associated with resistance to cancer chemotherapy and radiotherapy, we describe strategies that might be employed to suppress growth and overcome drug resistance in tumours with overactive NRF2

Epigenetic aging signatures in mice livers are slowed by dwarfism, calorie restriction and rapamycin treatment

Background: Global but predictable changes impact the DNA methylome as we age, acting as a type of molecular clock. This clock can be hastened by conditions that decrease lifespan, raising the question of whether it can also be slowed, for example, by conditions that increase lifespan. Mice are particularly appealing organisms for studies of mammalian aging; however, epigenetic clocks have thus far been formulated only in humans. Results: We first examined whether mice and humans experience similar patterns of change in the methylome with age. We found moderate conservation of CpG sites for which methylation is altered with age, with both species showing an increase in methylome disorder during aging. Based on this analysis, we formulated an epigenetic-aging model in mice using the liver methylomes of 107 mice from 0.2 to 26.0 months old. To examine whether epigenetic aging signatures are slowed by longevity-promoting interventions, we analyzed 28 additional methylomes from mice subjected to lifespan-extending conditions, including Prop1df/df dwarfism, calorie restriction or dietary rapamycin. We found that mice treated with these lifespan-extending interventions were significantly younger in epigenetic age than their untreated, wild-type age-matched controls. Conclusions: This study shows that lifespan-extending conditions can slow molecular changes associated with an epigenetic clock in mice livers

A method to advance adolescent sexual health research: Automated algorithm finds sexual history documentation

Background:We aimed to develop and validate a rule-based Natural Language Processing (NLP) algorithm to detect sexual history documentation and its five key components [partners, practices, past history of sexually transmitted infections (STIs), protection from STIs, and prevention of pregnancy] among adolescent encounters in the pediatric emergency and inpatient settings.MethodsWe iteratively designed a NLP algorithm using pediatric emergency department (ED) provider notes from adolescent ED visits with specific abdominal or genitourinary (GU) chief complaints. The algorithm is composed of regular expressions identifying commonly used phrases in sexual history documentation. We validated this algorithm with inpatient admission notes for adolescents. We calculated the sensitivity, specificity, negative predictive value, positive predictive value, and F1 score of the tool in each environment using manual chart review as the gold standard.ResultsIn the ED test cohort with abdominal or GU complaints, 97/179 (54%) provider notes had a sexual history documented, and the NLP algorithm correctly classified each note. In the inpatient validation cohort, 97/321 (30%) admission notes included a sexual history, and the NLP algorithm had 100% sensitivity and 98.2% specificity. The algorithm demonstrated >97% sensitivity and specificity in both settings for detection of elements of a high quality sexual history including protection used and contraception. Type of sexual practice and STI testing offered were also detected with >97% sensitivity and specificity in the ED test cohort with slightly lower performance in the inpatient validation cohort.ConclusionThis NLP algorithm automatically detects the presence of sexual history documentation and its key components in ED and inpatient settings

Microstructural and mechanical characterisation of post-tentioning strands following elevated temperature exposure

Prestressing strands lose strength and become more susceptible to creep deformation when they are heated during a fire. The consequent loss in prestressing force could under certain conditions result in structural collapse, potentially outwith the heated region of the structure. This paper describes a test programme characterising the changes in microstructure of steel prestressing tendons exposed to elevated temperatures. The residual strength tests, hardness testing, and elevated temperature mechanical test were performed to demonstrate how recovery and recrystallisation of the initially work-hardened steel produce changes in its mechanical properties at elevated temperatures. The research results of this paper are beneficial not only in the fire design of post-tensioned structures using modern prestressing steel, but also in the assessment of the tendons’ residual strength after being affected by fire