167 research outputs found
Individual and Work-Related Variables Contributing to Hospital Nurses\u27 Participation or Non-Participation in Available Clinical Career Ladder Programs.
One solution to overcome the shortage of hospital nurses is to establish and implement clinical career ladder programs. The purpose of this study was to examine hospital clinical nurses\u27 perceptions of ladder programs as a job enrichment strategy and to determine individual and work-related variables contributing most to nurses\u27 participation or nonparticipation in available clinical ladder programs. A random sample of 600 clinical nurses employed full time in five regional medical center hospitals located in Louisiana and Mississippi were the study subjects. Respondents were 106 (88.3%) of the 120 ladder program participants and 385 (80.2%) of the 480 nonparticipant nurses. A three section instrument was used for data collection and analysis: perceptions of clinical ladder programs; the Job Diagnostic Survey (JDS); demographic information. Section one was researcher developed to measure nurses\u27 perceptions of three factor areas of clinical ladder programs. The JDS measured the motivational potential of the clinical nurses\u27 job according to selected core job dimensions. The demographic section identified clinical nurses\u27 individual and work-related characteristics. The Chi square and t-test statistical procedures revealed that subjects by ladder program participation status were more alike than different on the demographic characteristics of gender, ethnic group, educational level, nursing practice unit, patient care delivery method and years\u27 clinical experience. However, significant differences were reported between nurse groups by program participation status and the variables age, shift worked, hours worked per shift and years present clinical position. A comparison between nurse groups by participation status and perceptions of clinical ladder programs showed significant differences in the factor areas of intrinsic and extrinsic outcomes, need for a ladder program and criteria for program advancement. Also, a t-test showed significant differences in the two groups\u27 JDS means task identity, feedback from agents, growth need satisfaction and job security. Using discriminant analysis, a model was found that correctly classified 75.69% of hospital nurses by program participation status group. The results suggest implications for nursing practice and future research studies of hospital clinical nurses and clinical ladder programs for job enrichment. A replication of this study to test the model was also recommended
Natural disturbance reduces disease risk in endangered rainforest frog populations
Natural disturbances can drive disease dynamics in animal populations by altering the microclimates experienced by hosts and their pathogens. Many pathogens are highly sensitive to temperature and moisture, and therefore small changes in habitat structure can alter the microclimate in ways that increase or decrease infection prevalence and intensity in host populations. Here we show that a reduction of rainforest canopy cover caused by a severe tropical cyclone decreased the risk of endangered rainforest frogs (Litoria rheocola) becoming infected by a fungal pathogen (Batrachochytrium dendrobatidis). Reductions in canopy cover increased the temperatures and rates of evaporative water loss in frog microhabitats, which reduced B. dendrobatidis infection risk in frogs by an average of 11–28% in cyclone-damaged areas, relative to una ected areas. Natural disturbances to the rainforest canopy can therefore provide an immediate bene t to frogs by altering the microclimate in ways that reduce infection risk. This could increase host survival and reduce the probability of epidemic disease outbreaks. For amphibian populations under immediate threat from this pathogen, targeted manipulation of canopy cover could increase the availability of warmer, drier microclimates and therefore tip the balance from host extinction to coexistence
Successful Land Use Planning for Small Towns: A Case Study of Bath, North Carolina
Many small coastal communities face the challenge of accommodating growth without pushing its high costs on residents. The Town of Bath, North Carolina is addressing its growth problems using the CAMA guidelines, state and federal funds and active citizen participation
Risk-taking behavior and the consumption of alcohol mixed with energy drink among Australian, Dutch and UK students
The relationship between risk-taking behavior, alcohol consumption and negative alcoholrelated consequences is well known. The current analyses were conducted to investigate whether alcohol mixed with energy drink (AMED) is related to risk-taking behavior and if there is a relationship between the amount of energy drink mixed with alcohol consumed, risk-taking behavior and negative alcohol-related consequences. Data from N = 1276 AMED consuming students from the Netherlands, UK and Australia who completed the same survey were evaluated. The analysis revealed that, compared to AMED occasions, on alcohol only (AO) occasions significantly more alcohol was consumed and significantly more negative alcohol-related consequences were reported. On both AO and AMED occasions, there was a strong and positive relationship between amount of alcohol consumed, level of risk-taking behavior and number of reported negative alcohol-related consequences. In contrast, the level of risk-taking behavior was not clearly related to energy drink consumption. Across risk-taking levels, differences in the amount of energy drink consumed on AMED occasions did not exceed one 250 mL serving of energy drink. When correcting for the amount of alcohol consumed, there were no statistically significant differences in the number of energy drinks consumed on AMED occasions between the risk-taking groups. In conclusion, alcohol consumption is clearly related to risk-taking behavior and experiencing negative alcohol-related consequences. In contrast, energy drink intake was not related to level of risk-taking behavior and only weakly related to the number of experienced negative alcohol-related consequences
Advantages and limitations of naturalistic study designs and their implementation in alcohol hangover research
In alcohol hangover research, both naturalistic designs and randomized controlled trials (RCTs) are successfully employed to study the causes, consequences, and treatments of hangovers. Although increasingly applied in both social sciences and medical research, the suitability of naturalistic study designs remains a topic of debate. In both types of study design, screening participants and conducting assessments on-site (e.g., psychometric tests, questionnaires, and biomarker assessments) are usually equally rigorous and follow the same standard operating procedures. However, they differ in the levels of monitoring and restrictions imposed on behaviors of participants before the assessments are conducted (e.g., drinking behaviors resulting in the next day hangover). These behaviors are highly controlled in RCTs and uncontrolled in naturalistic studies. As a result, the largest difference between naturalistic studies and RCTs is their ecological validity, which is usually significantly lower for RCTs and (related to that) the degree of standardization of experimental intervention, which is usually significantly higher for RCTs. In this paper, we specifically discuss the application of naturalistic study designs and RCTs in hangover research. It is debated whether it is necessary to control certain behaviors that precede the hangover state when the aim of a study is to examine the effects of the hangover state itself. If the preceding factors and behaviors are not in the focus of the research question, a naturalistic study design should be preferred whenever one aims to better mimic or understand real-life situations in experimental/intervention studies. Furthermore, to improve the level of control in naturalistic studies, mobile technology can be applied to provide more continuous and objective real-time data, without investigators interfering with participant behaviors or the lab environment impacting on the subjective state. However, for other studies, it may be essential that certain behaviors are strictly controlled. It is, for example, vital that both test days are comparable in terms of consumed alcohol and achieved hangover severity levels when comparing the efficacy and safety of a hangover treatment with a placebo treatment day. This is best accomplished with the help of a highly controlled RCT design
A cross-cultural comparison of the effects of alcohol mixed with energy drink (AMED) consumption on overall alcohol consumption and related consequences
There is a growing body of scientific literature examining the effects of alcohol mixed with energy drink (AMED) on alcohol consumption and related negative consequences, such as risky behavior or negative health effects. It is unknown whether differences in cultural context may influence these AMED effects. The current cross-cultural study compared the data of N = 6881 students from The Netherlands (N = 4424), UK (N = 1594), and Australia (N = 863). Demographics, alcohol consumption, its consequences, and motives for AMED consumption were assessed. Analyses included (a) between-groups comparison of AMED and alcohol only (AO) consumers, (b) within-subjects comparison of AMED and AO occasions among AMED consumers only, and (c) comparisons between the three countries. The between-groups analysis revealed that AMED consumers drink more alcohol than AO consumers (p < 0.001). AMED consumers differed from AO consumers in many other aspects. For example, AMED consumers were significantly more often a smoker and had higher risk-taking scores. Within subject analysis among AMED consumers showed that significantly less alcohol was consumed on AMED, compared to AO occasions (p < 0.001). These findings were observed for both typical drinking occasions and the past month’s heaviest drinking occasion, and were consistent across the three countries. Comparisons between countries revealed that on both AMED and AO occasions, the UK sample consumed significantly more alcohol than the Australian and Dutch samples. Across countries, neutral motives such as ‘I like the taste’ and ‘I wanted to drink something else’ were the most frequently reported motives for consuming AMED. The most notable difference between the countries was the finding that consuming AMED ‘To get drunk’ was endorsed significantly more often among the UK sample (45.6%) than the Australian (31.2%) and Dutch (8.0%) samples. Negative alcohol-related consequences were significantly less frequently reported for AMED occasions compared to AO occasions. Some country-specific consequences of AMED consumption were observed, but these were more likely related to characteristics of the country and their drinking culture (e.g., the Australian sample reported more often driving a car after AMED consumption compared to the other countries, and this pattern of results was also found for AO occasions). In conclusion, there were limited differences between countries with regard to demographics of consumers and motives for AMED consumption, but the UK sample consumed significantly more alcohol and reported the highest frequency of negative alcohol related consequences. Consistent across countries was the observation that AMED consumers consume significantly less alcohol on their past month heaviest AMED drinking occasion, compared to their past month heaviest AO drinking occasion
Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention
Abstract
Introduction
Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer.
Methods
We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes.
Results
Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067.
Conclusions
The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed.
Trial registration
ClinicalTrials.gov:
NCT00967824http://deepblue.lib.umich.edu/bitstream/2027.42/112557/1/13058_2013_Article_3282.pd
Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention
Abstract
Introduction
Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer.
Methods
We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline . The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes.
Results
Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067.
Conclusions
The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed.
Trial registration
ClinicalTrials.gov:
NCT00967824http://deepblue.lib.umich.edu/bitstream/2027.42/135728/1/13058_2013_Article_3282.pd
A worldwide study of white matter microstructural alterations in people living with Parkinson’s disease
The progression of Parkinson’s disease (PD) is associated with microstructural alterations in neural pathways, contributing to both motor and cognitive decline. However, conflicting findings have emerged due to the use of heterogeneous methods in small studies. Here we performed a large diffusion MRI study in PD, integrating data from 17 cohorts worldwide, to identify stage-specific profiles of white matter differences. Diffusion-weighted MRI data from 1654 participants diagnosed with PD (age: 20–89 years; 33% female) and 885 controls (age: 19–84 years; 47% female) were analyzed using the ENIGMA-DTI protocol to evaluate white matter microstructure. Skeletonized maps of fractional anisotropy (FA) and mean diffusivity (MD) were compared across Hoehn and Yahr (HY) disease groups and controls to reveal the profile of white matter alterations at different stages. We found an enhanced, more widespread pattern of microstructural alterations with each stage of PD, with eventually lower FA and higher MD in almost all regions of interest: Cohen’s d effect sizes reached d = −1.01 for FA differences in the fornix at PD HY Stage 4/5. The early PD signature in HY stage 1 included higher FA and lower MD across the entire white matter skeleton, in a direction opposite to that typical of other neurodegenerative diseases. FA and MD were associated with motor and non-motor clinical dysfunction. While overridden by degenerative changes in the later stages of PD, early PD is associated with paradoxically higher FA and lower MD in PD, consistent with early compensatory changes associated with the disorder
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