Factors Affecting the Self-directed Learning of Students at Clinical Practice Course for Advanced Practice Nurse

PurposeThe current study aimed to examine the casual relationships among belongingness during clinical practice, stress, satisfaction with clinical practice, and self-esteem, which are factors affecting the self-directed learning that results from the clinical practice of advanced practice nurse (APN) students.MethodsData were collected between April 5 and May 19, 2010, from 202 students in 11 APN training institutions located in and outside of Seoul, who were selected using convenience sampling. For hypothesis testing, the collected data were analyzed using AMOS 8.0.ResultsAnalysis of the path coefficients in this study showed that 37% of the variation in self-directed learning could be explained by variations in the model. Self-esteem and belongingness during clinical practice directly affected the self-directed learning of APN students, and belongingness also had an indirect effect via self-esteem. However, stress and satisfaction with clinical practice had no significant mediating effect on self-directed learning. At the same time, belongingness during clinical practice was found to be a good predictive factor to explain stress and satisfaction with clinical practice.ConclusionsThis study demonstrated the hierarchical relationship among belongingness, self-esteem, and self-directed learning based on the conceptual framework developed by Levett-Jones and Lathlean, thus proving the usefulness of this framework for application in the field. Therefore, this study found that there are needs of high self-esteem and belongingness in order to improve self-directed learning for APN students in clinical practice

The impact of Arctic sea ice loss on mid-Holocene climate.

Mid-Holocene climate was characterized by strong summer solar heating that decreased Arctic sea ice cover. Motivated by recent studies identifying Arctic sea ice loss as a key driver of future climate change, we separate the influences of Arctic sea ice loss on mid-Holocene climate. By performing idealized climate model perturbation experiments, we show that Arctic sea ice loss causes zonally asymmetric surface temperature responses especially in winter: sea ice loss warms North America and the North Pacific, which would otherwise be much colder due to weaker winter insolation. In contrast, over East Asia, sea ice loss slightly decreases the temperature in early winter. These temperature responses are associated with the weakening of mid-high latitude westerlies and polar stratospheric warming. Sea ice loss also weakens the Atlantic meridional overturning circulation, although this weakening signal diminishes after 150-200 years of model integration. These results suggest that mid-Holocene climate changes should be interpreted in terms of both Arctic sea ice cover and insolation forcing

Flood Estimation and Prediction Using Particle Filters

Data assimilation methods have received increased attention to accomplish uncertainty assessment and enhancement of forecasting capability in various areas. Despite their potential, applicable software frameworks for probabilistic approaches and data assimilation are still limited because most hydrologic modeling software are based on a deterministic approach. In this study, we developed a hydrologic modeling framework for data assimilation, namely MPI-OHyMoS. While adapting object-oriented features of the original OHyMoS, MPI-OHyMoS allows user to build a probabilistic hydrologic model with data assimilation. In this software framework, sequential data assimilation based on particle filtering is available for any hydrologic models considering various sources of uncertainty originating from input forcing, parameters, and observations. Ensemble simulations are parallelized by a message passing interface (MPI), which can take advantage of high-performance computing (HPC) systems. Structure and implementation processes of data assimilation via MPI-OHyMoS are illustrated using a simple lumped model. We apply this software framework for uncertainty assessment of a distributed hydrologic model in synthetic and real experiment cases. In the synthetic experiment, dual state-parameter updating results in a reasonable estimation of parameters to cover synthetic true within their posterior distributions. In the real experiment, dual updating with identifiable parameters results in a reasonable agreement to the observed hydrograph with reduced uncertainty of parameters

Psychometric properties of a short self-reported measure of medication adherence among patients with hypertension treated in a busy clinical setting in Korea.

BackgroundWe examined the psychometric properties of the Korean version of the 8-item Morisky Medication Adherence Scale (MMAS-8) among adults with hypertension.MethodsA total of 373 adults with hypertension were given face-to-face interviews in 2 cardiology clinics at 2 large teaching hospitals in Seoul, South Korea. Blood pressure was measured twice, and medical records were reviewed. About one-third of the participants (n = 109) were randomly selected for a 2-week test-retest evaluation of reliability via telephone interview.ResultsInternal consistency reliability was moderate (Cronbach α = 0.56), and test-retest reliability was excellent (intraclass correlation = 0.91; P < 0.001), although a ceiling effect was detected. The correlation of MMAS-8 scores with scores for the original 4-item scale indicated that convergent validity was good (r = 0.92; P < 0.01). A low MMAS-8 score was significantly associated with poor blood pressure control (χ(2) = 29.86; P < 0.001; adjusted odds ratio = 5.08; 95% CI, 2.56-10.08). Using a cut-off point of 6, sensitivity and specificity were 64.3% and 72.9%, respectively. Exploratory factor analysis identified 3 dimensions of the scale, with poor fit for the 1-dimensional construct using confirmatory factory analysis.ConclusionsThe MMAS-8 had satisfactory reliability and validity and thus might be suitable for assessment and counseling regarding medication adherence among adults with hypertension in a busy clinical setting in Korea

Comparison of tracheal temperature and core temperature measurement in living donor liver transplant recipients: a clinical comparative study

Abstract Background Body temperature is a vital sign, and temperature monitoring during liver transplantation is important. Tracheal temperature can be measured via an endotracheal tube with a temperature sensor on the cuff of the tube. This study aimed to investigate the accuracy and trending ability of tracheal temperature measurement compared to those of the core temperature measured at the esophagus and pulmonary artery (PA) in living donor liver transplant recipients. Methods Twenty-two patients who underwent living donor liver transplantation (LDLT) were enrolled. Patients were intubated using an endotracheal tube with a temperature sensor placed on the inner surface of the tube cuff. Tracheal, esophageal, and PA temperatures were recorded at five time points corresponding to the different phases of liver transplantation. The tracheal and esophageal, tracheal and PA, and esophageal and PA temperatures were compared using Bland–Altman analysis, four-quadrant plot/concordance analysis, and polar plot analysis. Results Bland–Altman analysis showed an overall mean bias (95% limits of agreement) between tracheal and esophageal temperatures of -0.10°C (-0.37°C to 0.18°C), with a percentage error of 0.27%; between tracheal and PA temperatures, -0.05°C (-0.91°C to 0.20°C), with a percentage error of -0.15%; and between esophageal and PA temperatures, 0.04°C (-0.27°C to 0.35°C), with a percentage error of 0.12%. The concordance rates between tracheal and esophageal temperatures, tracheal and PA temperatures, and esophageal and PA temperatures were 96.2%, 96.2%, and 94.94%, respectively. The polar plot analysis showed a mean angular bias (radial limits of agreement) of 4° (26°), -3° (13°), and 2° (21°). Conclusions Monitoring core temperature at the inner surface of the endotracheal tube cuff is accurate in all phases of LDLT with good trending ability; thus, it can be an excellent alternative for monitoring during LDLTs