Professional development among newly graduated registered nurses working in acute care hospital settings: A qualitative explorative study

Aim To explore newly graduated registered nurses' perceptions of their work situation and management of nursing care in complex patient situations after 18 months of work experience. Background Newly graduated registered nurses working in acute care hospital settings play a critical role in providing safe nursing care. Methods An explorative qualitative design, with four focus group interviews with 14 newly graduated registered nurses working in acute care hospital settings. Results One theme emerged: ‘Clarity and security in one's own nursing role despite facing challenges that hinder professional development’ and three categories: ‘Independency due to one's own efforts and experience’, ‘Well-functioning teamwork’ and ‘Challenges in the work situation’. Conclusion After 18 months in the profession, the nurses were considered to be advanced beginners; at the same time, the most experienced nurses on their respective wards. They found it challenging and need to further develop competences concerning managing and organizing the nursing care of several complex patient situations or new patient groups, as well as supervising novice registered nurses and nursing students. Implication for Nursing Management Powerful and urgent action is needed to be taken by national healthcare policymakers as well a hospital and nurse managers to develop long-term strategies to improve working conditions for newly registered graduated nurses.publishedVersio

The Effects of Patchy Reionization on Satellite Galaxies of the Milky Way

We combine the high-resolution Aquarius simulations with three-dimensional models of reionization based on the initial density field of the Aquarius parent simulation, Millennium-II, to study the impact of patchy reionization on the faint satellite population of Milky Way halos. Because the Aquarius suite consists of zoom-in simulations of halos in the Millennium-II volume, we follow the formation of substructure and the growth of reionization bubbles due to the larger environment simultaneously, and thereby determine the reionization redshifts of satellite candidates. We do this for four different reionization models, and also compare results to instantaneous reionization. Using a simple procedure for selecting satellites and assigning luminosities in the simulations, we compare the resulting satellite populations. We find that the overall number of satellites depends sensitively on the reionization model, with a factor of 3-4 variation between the four models for a given host halo, although the difference is entirely in the population of faint satellites (M_V > -10). In addition, we find that for a given reionization model the total number of satellites differs by 10%-20% between the patchy and homogeneous scenarios, provided that the redshift is chosen appropriately for the instantaneous case. However, the halo-halo scatter from the six Aquarius halos is large, up to a factor of 2-3, and so is comparable to the difference between reionization scenarios. In order to use the population of faint dwarf galaxies around the Milky Way as a probe of the local reionization history, then, it is necessary to first better understand the general distribution of substructure around Milky Way-mass halos.Comment: Matches published version. Reionization discussion expanded, major conclusions unchange

Pulmonary exposure to single-walled carbon nanotubes does not affect the early immune response against Toxoplasma gondii

Background Single-walled carbon nanotubes (SWCNT) trigger pronounced inflammation and fibrosis in the lungs of mice following administration via pharyngeal aspiration or inhalation. Human exposure to SWCNT in an occupational setting may occur in conjunction with infections and this could yield enhanced or suppressed responses to the offending agent. Here, we studied whether the sequential exposure to SWCNT via pharyngeal aspiration and infection of mice with the ubiquitous intracellular parasite Toxoplasma gondii would impact on the immune response of the host against the parasite. Methods C57BL/6 mice were pre-exposed by pharyngeal administration of SWCNT (80 + 80 μg/mouse) for two consecutive days followed by intravenous injection with either 1x103 or 1x104 green fluorescence protein and luciferase-expressing T. gondii tachyzoites. The dissemination of T. gondii was monitored by in vivobioluminescence imaging in real time for 7 days and by plaque formation. The inflammatory response was analysed in bronchoalveolar lavage (BAL) fluid, and by assessment of morphological changes and immune responses in lung and spleen. Results There were no differences in parasite distribution between mice only inoculated with T. gondii or those mice pre-exposed for 2 days to SWCNT before parasite inoculum. Lung and spleen histology and inflammation markers in BAL fluid reflected the effects of SWCNT exposure and T. gondii injection, respectively. We also noted that CD11c positive dendritic cells but not F4/80 positive macrophages retained SWCNT in the lungs 9 days after pharyngeal aspiration. However, co-localization of T. gondii with CD11c or F4/80 positive cells could not be observed in lungs or spleen. Pre-exposure to SWCNT did not affect the splenocyte response to T. gondii. Conclusions Taken together, our data indicate that pre-exposure to SWCNT does not enhance or suppress the early immune response to T. gondii in mice

High-Resolution Spectroscopy of Extremely Metal-Poor Stars in the Least Evolved Galaxies: Ursa Major II and Coma Berenices

We present Keck/HIRES observations of six metal-poor stars in two of the ultra-faint dwarf galaxies orbiting the Milky Way, Ursa Major II and Coma Berenices. These observations include the first high-resolution spectroscopic observations of extremely metal-poor stars ([Fe/H]<-3.0) stars not belonging to the Milky Way (MW) halo field star population. We obtain abundance measurements and upper limits for 26 elements between carbon and europium. The entire sample of stars spans a range of -3.2<[Fe/H]<-2.3, and we confirm that each galaxy contains a large intrinsic spread of Fe abundances. A comparison with MW halo stars of similar metallicities reveals substantial agreement between the abundance patterns of the ultra-faint dwarf galaxies and the MW halo for the light, alpha and iron-peak elements (C to Zn). This agreement contrasts with the results of earlier studies of more metal-rich stars (-2.5<[Fe/H]<-1.0) in more luminous dwarf spheroidal galaxies (dSphs), which found significant abundance discrepancies with respect to the MW halo data. The abundances of neutron-capture elements (Sr to Eu) in the ultra-faint dwarf galaxies are extremely low, consistent with the most metal-poor halo stars, but not with the typical halo abundance pattern at [Fe/H]>-3.0. Our results are broadly consistent with a galaxy formation model that predicts that massive dwarf galaxies are the source of the metal-rich component ([Fe/H]>-2.5) of the MW halo, but we also suggest that the faintest known dwarfs may be the primary contributors to the metal-poor end of the MW halo metallicity distribution.Comment: Accepted for publication in ApJ, emulateapj-style, 29 pages incl. figures and table

AML risk stratification models utilizing ELN-2017 guidelines and additional prognostic factors: a SWOG report.

Background: The recently updated European LeukemiaNet risk stratification guidelines combine cytogenetic abnormalities and genetic mutations to provide the means to triage patients with acute myeloid leukemia for optimal therapies. Despite the identification of many prognostic factors, relatively few have made their way into clinical practice. Methods: In order to assess and improve the performance of the European LeukemiaNet guidelines, we developed novel prognostic models using the biomarkers from the guidelines, age, performance status and select transcript biomarkers. The models were developed separately for mononuclear cells and viable leukemic blasts from previously untreated acute myeloid leukemia patients (discovery cohort, Results: Models using European LeukemiaNet guidelines were significantly associated with clinical outcomes and, therefore, utilized as a baseline for comparisons. Models incorporating age and expression of select transcripts with biomarkers from European LeukemiaNet guidelines demonstrated higher area under the curve and C-statistics but did not show a substantial improvement in performance in the validation cohort. Subset analyses demonstrated that models using only the European LeukemiaNet guidelines were a better fit for younger patients (age \u3c 55) than for older patients. Models integrating age and European LeukemiaNet guidelines visually showed more separation between risk groups in older patients. Models excluding results for Conclusions: While European LeukemiaNet guidelines remain a critical tool for triaging patients with acute myeloid leukemia, the findings illustrate the need for additional prognostic factors, including age, to improve risk stratification

LSST Science Book, Version 2.0

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy.Comment: 596 pages. Also available at full resolution at http://www.lsst.org/lsst/sciboo

Kinematics and chemistry of recently discovered Reticulum 2 and Horologium 1 dwarf galaxies

Photometry alone is not sufficient to unambiguously distinguish between ultra-faint star clusters and dwarf galaxies because of their overlap in morphological properties. Here we report on VLT/GIRAFFE spectra of candidate member stars in two recently discovered ultra-faint satellites Reticulum 2 and Horologium 1, obtained as part of the ongoing Gaia-ESO Survey. We identify 18 members in Reticulum 2 and 5 in Horologium 1. We find Reticulum 2 to have a velocity dispersion of ~3.22 km/s, implying a M/L ratio of ~ 500. We have inferred stellar parameters for all candidates and we find Reticulum 2 to have a mean metallicity of [Fe/H] = -2.46+/-0.1, with an intrinsic dispersion of ~ 0.29, and is alpha-enhanced to the level of [alpha/Fe]~0.4. We conclude that Reticulum 2 is a dwarf galaxy. We also report on the serendipitous discovery of four stars in a previously unknown stellar substructure near Reticulum 2 with [Fe/H] ~ -2 and V_hel ~ 220 km/s, far from the systemic velocity of Reticulum 2. For Horologium 1 we infer a velocity dispersion of 4.9^{+2.8}_{-0.9} km/s and a consequent M/L ratio of ~ 600, leading us to conclude that Horologium 1 is also a dwarf galaxy. Horologium 1 is slightly more metal-poor than Reticulum 2 [Fe/H] = -2.76 +/- 0.1 and is similarly alpha-enhanced: [alpha/Fe] ~ 0.3. Despite a large error-bar, we also measure a significant spread of metallicities of 0.17 dex which strengthen the evidence that Horologium 1 is indeed a dwarf galaxy. The line-of-sight velocity of Reticulum 2 is offset by some 100 km/s from the prediction of the orbital velocity of the LMC, thus making its association with the Cloud uncertain. However, at the location of Horologium 1, both the backward integrated LMC's orbit and the LMC's halo are predicted to have radial velocities similar to that of the dwarf. Therefore, it is likely that Horologium 1 is or once was a member of the Magellanic Family.Comment: submitted to ApJ, abstract abridge

Newly graduated registered nurses’ clinical competence, professional development and work situation : In acute care hospital settings

The overall aim of this thesis was to explore and describe newly graduated registered nurses’ self-assessed clinical competences, professional development, work situation, and perceptions of managing nursing care in complex patient situations during their first 18 months of clinical practice in acute care hospital settings. Methods: Cross-sectional and longitudinal data were collected from NGRNs with 2-15 months of work experience using the instrument Professional Nurse Self-Assessment Scale of clinical core competences II. Qualitative data were collected through focus group interviews with NGRNs after both six and 18 months of work experience. Main results: After two months of work experience, participating NGRNs rated their clinical competence as being highest in clinical leadership and lowest in professional development. Need for further training was greatest in direct clinical practice and lowest in collaborating. After 6 months of work experience, the NGRNs were not being sufficiently prepared and supported to meet responsibilities and demands. Between 2 and 15 months, clinical competence was assessed highest in ethics, teamwork and clinical leadership, lowest in professional development and critical thinking. The need for further training was highest in direct clinical practice, lowest in ethics, teamwork and clinical leadership. Self-rated clinical competence increased substantially when the NGRNs had worked between 9-15 months and after 18 months, nurses generally felt secure in their roles but faced challenges with regard to work situations that hindered their professional development. Conclusion: These results demonstrate the importance of improving NGRNs’ work situation and supporting their development of clinical competence including their need for further training, which would contribute to increased quality of care and patient safety as well as increased professional development among NGRNs.Newly graduated registered nurses working in acute care hospital settings need to be able to provide safe nursing care in a fast-changing healthcare system with an increasing number of complex patient situations and ongoing nursing shortages. The overall aim of this thesis was to explore and describe newly graduated registered nurses’ self-assessed clinical competence, professional development, work situation, and perception of their ability to manage nursing care in complex patient situations during their first 18 months of clinical practice in acute care hospital settings. Newly graduated registered nurses’ clinical competence increased over time, however, they continued to need support from experienced nurses to manage nursing care in complex patient situations. It is important to improve NGRNs’ work situation and support their clinical competence development based on their need for further training, which would contribute to increasing the quality of care they provide, patient safety, and professional development

Ethics and aesthetics in injection treatments with Botox and Filler

The medical nature of esthetic treatments is confusing, as the boundaries between medicine and beauty are unclear. A person's autonomous decision is an indicator for esthetic treatments that will improve their self-image, self-esteem and appearance to others. Robust ethical consideration is therefore necessary for the medical esthetician in each meeting with the client. This study aimed to describe medical estheticians' perceptions of ethics and esthetics in injection treatments with Botox and Filler. The results are described in Understanding what different clients desire, Reaching a mutual understanding of expectations and possibilities and Taking responsibility for beauty