The Impact of Limited Clinical Sites on Prelicensure Nursing Education Programs: Current Issues and Recommendations for the Future

Nursing is an ever-changing field. Issues exist. Healthcare is at a crossroads and nursing is at the forefront of influencing change. Many obstacles challenge prelicensure nursing programs today. One prominent issue is the lack of inpatient clinical sites to prepare students for nursing practice. Many factors contribute to this worsening problem including, but not limited to, a looming nursing shortage, faculty shortage, lack of collaboration between nurses in academic and practice settings and with other healthcare professionals, cost, and safety and liability issues. This paper examines the impact of limited clinical sites on the preparation of nurses for professional practice and proposes recommendations that emphasize service-learning and community-based practice learning experiences, which are viable options for many nursing programs

Something Old, Something New: MBA Program Evaluation Using Shift-Share Analysis and Google Trends

Shift-share analysis is a decomposition technique that is commonly used to measure attributes of regional change. In this method, regional change is decomposed into its relevant functional and competitive parts. This paper introduces traditional shift-share method and its extensions with examples of its applicability and usefulness for program evaluation and development, strategic planning, enrollment management and other traditional functions of higher education administration. To illustrate we provide an appraisal of the impact of demographic and employment changes resulting from the great recession on the MBA program of a regional private university in the state of Connecticut. We establish the validity of our shift-share based analysis with a Google Trends examination of relevant keywords

Accuracy and consistency of grass pollen identification by human analysts using electron micrographs of surface ornamentation

• Premise of the study: Humans frequently identify pollen grains at a taxonomic rank above species. Grass pollen is a classic case of this situation, which has led to the development of computational methods for identifying grass pollen species. This paper aims to provide context for these computational methods by quantifying the accuracy and consistency of human identification. • Methods: We measured the ability of nine human analysts to identify 12 species of grass pollen using scanning electron microscopy images. These are the same images that were used in computational identifications. We have measured the coverage, accuracy, and consistency of each analyst, and investigated their ability to recognize duplicate images. • Results: Coverage ranged from 87.5% to 100%. Mean identification accuracy ranged from 46.67% to 87.5%. The identification consistency of each analyst ranged from 32.5% to 87.5%, and each of the nine analysts produced considerably different identification schemes. The proportion of duplicate image pairs that were missed ranged from 6.25% to 58.33%. • Discussion: The identification errors made by each analyst, which result in a decline in accuracy and consistency, are likely related to psychological factors such as the limited capacity of human memory, fatigue and boredom, recency effects, and positivity bias

Body Fat Percentage and Hormonal Intrauterine Device Use Are Independently Associated with Self-Reported Menstrual Regularity in Young Adult Females

Menstrual regularity is a key indicator of energy availability, long-term bone density, and other important health information in females. The occurrence of a regular menstrual cycle indicates that an individual’s level of estrogen is supportive of strong bones and that they are achieving the caloric intake required to support their activity level. In contrast, an irregular menstrual cycle can be indicative of insufficient energy availability which may, over time, result in low bone mineral density and thus a higher risk of bone stress injuries. However, hormonal contraceptive use, including the rising use of intrauterine devices (IUDs), may mask these changes in menstrual regularity. PURPOSE: The purpose of this study was to examine factors related to self-reported menstrual regularity among a population of young, generally healthy females. METHODS: Participants were included if they were no more than 50 years of age at the time of enrollment and had less than 50% body fat as assessed via dual-energy x-ray absorptiometry (DXA). Participants were asked via questionnaire if they reported having a regular menstrual cycle, defined as menstrual periods occurring at predictable intervals and no missed periods in the past six months. Additionally, participants were asked if they were currently using any form of hormonal contraception, and if so, what type. A logistic regression was run with menstrual regularity (1 = regular; 0 = irregular) as the dependent variable and body fat percentage (BFP) and contraceptive type as the predictors. RESULTS: Out of the 76 participants (mean±SD age: 23.2±5.1 years; height: 164.5±6.5 cm; weight: 65.2±13.6 kg; BFP: 32.3±8.5%), 54 (71%) reported having a regular menstrual cycle. Of the 45 (59%) participants using hormonal contraception, 27 (60%) used a combined oral contraceptive pill, six (13%) used a progestin-only pill, nine (20%) used an IUD, two (4%) used a hormonal implant, and one (2%) used a vaginal ring. Overall, a higher BFP was associated with a greater likelihood of menstrual regularity (coefficient±SE: 0.08 ± 0.04; p = 0.04) while IUD use was associated with a lower likelihood (coefficient±SE: -1.8 ± 0.9; p = 0.04). No other hormonal contraception type was independently associated with self-reported menstrual regularity. CONCLUSION: These results collectively suggest, within a population of generally healthy, young adult females, that lower BFP and hormonal IUD use are both independently associated with a lower likelihood of having a regular menstrual cycle. When assessing the lack of a regular menstrual cycle, practitioners may consider hormonal IUD use as one potential factor in addition to a general assessment of body composition and energy availability. However, this analysis was limited by a relatively small sample size, which may have reduced the ability to detect the relationship between menstrual regularity and less commonly used contraceptive types. Future research is required to determine the relationship between these contraceptive types and menstrual regularity in generally healthy adult females

Alternative Options for Complex, Recurrent Pain States Using Cannabinoids, Psilocybin, and Ketamine: A Narrative Review of Clinical Evidence

With emerging information about the potential for morbidity and reduced life expectancy with long-term use of opioids, it is logical to evaluate nonopioid analgesic treatments to manage pain states. Combinations of drugs can provide additive and/or synergistic effects that can benefit the management of pain states. In this regard, tetrahydrocannabinol (THC) and cannabidiol (CBD) modulate nociceptive signals and have been studied for chronic pain treatment. Psilocybin, commonly known as magic mushrooms , works at the serotonin receptor, 5-HT. Psilocybin has been found in current studies to help with migraines since it has a tryptamine structure and works similarly to triptans. Psilocybin also has the potential for use in chronic pain treatment. However, the studies that have looked at alternative plant-based medications such as THC, CBD, and psilocybin have been small in terms of their sample size and may not consider the demographic or genetic differences in the population because of their small sample sizes. At present, it is unclear whether the effects reported in these studies translate to the general population or even are significant. In summary, additional studies are warranted to evaluate chronic pain management with alternative and combinations of medications in the treatment of chronic pain

Estradiol Regulation of Nucleotidases in Female Reproductive Tract Epithelial Cells and Fibroblasts

The use of topical and oral adenosine derivatives in HIV prevention that need to be maintained in tissues and cells at effective levels to prevent transmission prompted us to ask whether estradiol could influence the regulation of catabolic nucleotidase enzymes in epithelial cells and fibroblasts from the upper and lower female reproductive tract (FRT) as these might affect cellular TFV-DP levels. Epithelial cells and fibroblasts were isolated from endometrium (EM), endocervix (CX) and ectocervix (ECX) tissues from hysterectomy patients, grown to confluence and treated with or without estradiol prior to RNA isolation. The expression of nucleotidase (NT) genes was measurable by RT-PCR in epithelial cells and fibroblasts from all FRT tissues. To determine if sex hormones have the potential to regulate NT, we evaluated NT gene expression and NT biological activity in FRT cells following hormone treatment. Estradiol increased expression of Cytosolic 5 9 -nucleotidase after 2 or 4 h in endometrial epithelial cells but not epithelial cells or fibroblasts from other sites. In studies using a modified 5 9 - Nucleotidase biological assay for nucleotidases, estradiol increased NT activity in epithelial cells and fibroblasts from the EM, CX and ECX at 24 and 48 h. In related studies, HUVEC primary cells and a HUVEC cell line were unresponsive to estradiol in terms of nucleotidase expression or biological activity. Our findings of an increase in nucleotidase expression and biological activity induced by estradiol do not directly assess changes in microbicide metabolism. However, they do suggest that when estradiol levels are elevated during the menstrual cycle, FRT epithelial cells and fibroblasts from the EM, CX and ECX have the potential to influence microbicide levels that could enhance protection of HIV-target cells (CD4 + T cells, macrophages and dendritic cells) throughout the FRT

The impact of histopathology and NAB2-STAT6 fusion subtype in classification and grading of meningeal solitary fibrous tumor/hemangiopericytoma.

Meningeal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is a rare tumor with propensity for recurrence and metastasis. Although multiple classification schemes have been proposed, optimal risk stratification remains unclear, and the prognostic impact of fusion status is uncertain. We compared the 2016 WHO CNS tumor grading scheme (CNS-G), a three-tier system based on histopathologic phenotype and mitotic count, to the 2013 WHO soft-tissue counterpart (ST-G), a two-tier system based on mitotic count alone, in a cohort of 133 patients [59 female, 74 male; mean age 54 years (range 20-87)] with meningeal SFT/HPC. Tumors were pathologically confirmed through review of the first tumor resection (n = 97), local recurrence (n = 35), or distant metastasis (n = 1). A STAT6 immunostain showed nuclear expression in 132 cases. NAB2-STAT6 fusion was detected in 99 of 111 successfully tested tumors (89%) including the single STAT6 immunonegative tumor. Tumors were classified by CNS-G as grade 1 (n = 43), 2 (n = 41), or 3 (n = 49), and by ST-G as SFT (n = 84) or malignant SFT (n = 49). Necrosis was present in 16 cases (12%). On follow-up, 42 patients had at least one subsequent recurrence or metastasis (7 metastasis only, 33 recurrence only, 2 patients had both). Twenty-nine patients died. On univariate analysis, necrosis (p = 0.002), CNS-G (p = 0.01), and ST-G (p = 0.004) were associated with recurrence-free (RFS) but not overall survival (OS). NAB2-STAT6 fusion type was not significantly associated with RFS or OS, but was associated with phenotype. A modified ST-G incorporating necrosis showed higher correlation with RFS (p = 0.0006) and remained significant (p = 0.02) when considering only the primary tumors. From our data, mitotic rate and necrosis appear to stratify this family of tumors most accurately and could be incorporated in a future grading scheme