Evaluation of a Revised Clinical Ladder Program in Addressing Clinical Competence and Performance, Accountability, Professional Growth, Rewards and Benefits, Job Satisfaction and Engagement, and Autonomy and Decision Making

Background: The surge of nurses leaving the profession has increased in recent years raising concerns that unless systemwide changes are implemented this trend will increase exponentially for years to come. Healthcare organizations struggle to retain an experienced, competent nursing workforce and seek ways to keep them from leaving. A clinical ladder program is one potential method being implemented in which healthcare organizations mitigate the exodus of nurses and create a healthier work environment. Objectives: This doctoral project aimed to measure the perceptions of how well a revised clinical ladder program influenced the nursing workforce satisfaction in the following areas: clinical competence and performance, accountability, professional growth, rewards and benefits, job satisfaction and engagement, and autonomy and decision making. Methods: A descriptive study was used for this project. All participants of the study site’s clinical ladder program were surveyed regarding how well the revised program addressed the content areas. A modified clinical ladder assessment tool was used to create three surveys distributed and responses received over a 15-week study period. Results were analyzed for impact on the stated objectives. Results: The overall grand mean for all three surveys was 3.05 (SD = 0.72). Clinical Performance rated highest (3.56, SD = 0.74) and Rewards and Benefits rated lowest (2.50, SD = 0.96). Total scores (F(2, 155) = 0.126, p = .88) and subscores (F(9.89, 766.56) = 0.528, p = .87) did not change over time. Clinical Nurse III participants reported a higher total mean score of 3.28 (95% CI (3.11, 3.45) than Clinical Nurse II participants. Differences between time intervals and participants’ program tracks were not statistically significant. Conclusion: Survey respondents rated the study site’s current nursing clinical ladder program a 3.05 on a five-point scale. Results indicated that the overall general evaluation of the program did not improve or worsen across the three survey waves; however, Clinical Nurse III participants generally rated the clinical ladder program more favorably. Responses did not vary based on participant’s program track

Closing the sea surface mixed layer temperature budget from in situ observations alone: Operation Advection during BoBBLE

Sea surface temperature (SST) is a fundamental driver of tropical weather systems such as monsoon rainfall and tropical cyclones. However, understanding of the factors that control SST variability is lacking, especially during the monsoons when in situ observations are sparse. Here we use a ground-breaking observational approach to determine the controls on the SST variability in the southern Bay of Bengal. We achieve this through the first full closure of the ocean mixed layer energy budget derived entirely from in situ observations during the Bay of Bengal Boundary Layer Experiment (BoBBLE). Locally measured horizontal advection and entrainment contribute more significantly than expected to SST evolution and thus oceanic variability during the observation period. These processes are poorly resolved by state-of-the-art climate models, which may contribute to poor representation of monsoon rainfall variability. The novel techniques presented here provide a blueprint for future observational experiments to quantify the mixed layer heat budget on longer time scales and to evaluate these processes in models

Speech rhythm of the Danish-Chinese interlanguage relies on rhyme structure

Although speech rhythm is a highly important factor in theevaluation of nativeness, it is usually not explicitly taught insecond language acquisition. Moreover, acquisition studiesof Mandarin prosody typically focus on the acquisition oftone. We investigated durational patterns of MandarinChinese as produced by Danish learners. Native MandarinChinese rhythm is characterized by, first, sentence-finalsyllable lengthening, then tone-intrinsic duration, andfinally, rhyme structure. Danish speech rhythm isfundamentally different, since Danish is a stress languagewith only primary stress on the level of the phonologicalphrase, and extensive reduction of unstressed syllables. Weshow that the interlanguage of Danish learners of Chinese iscomparable to native Mandarin Chinese duration patternswith regard to rhyme structure. However, differentiation ofduration based on tone and final lengthening lags behind inDanish acquisition of Chinese.Language Use in Past and Presen

Modelling diverse root density dynamics and deep nitrogen uptake — a simple approach

We present a 2-D model for simulation of root density and plant nitrogen (N) uptake for crops grown in agricultural systems, based on a modification of the root density equation originally proposed by Gerwitz and Page in J Appl Ecol 11:773–781, (1974). A root system form parameter was introduced to describe the distribution of root length vertically and horizontally in the soil profile. The form parameter can vary from 0 where root density is evenly distributed through the soil profile, to 8 where practically all roots are found near the surface. The root model has other components describing root features, such as specific root length and plant N uptake kinetics. The same approach is used to distribute root length horizontally, allowing simulation of root growth and plant N uptake in row crops. The rooting depth penetration rate and depth distribution of root density were found to be the most important parameters controlling crop N uptake from deeper soil layers. The validity of the root distribution model was tested with field data for white cabbage, red beet, and leek. The model was able to simulate very different root distributions, but it was not able to simulate increasing root density with depth as seen in the experimental results for white cabbage. The model was able to simulate N depletion in different soil layers in two field studies. One included vegetable crops with very different rooting depths and the other compared effects of spring wheat and winter wheat. In both experiments variation in spring soil N availability and depth distribution was varied by the use of cover crops. This shows the model sensitivity to the form parameter value and the ability of the model to reproduce N depletion in soil layers. This work shows that the relatively simple root model developed, driven by degree days and simulated crop growth, can be used to simulate crop soil N uptake and depletion appropriately in low N input crop production systems, with a requirement of few measured parameters

An overview of the current status of CMB observations

In this paper we briefly review the current status of the Cosmic Microwave Background (CMB) observations, summarising the latest results obtained from CMB experiments, both in intensity and polarization, and the constraints imposed on the cosmological parameters. We also present a summary of current and future CMB experiments, with a special focus on the quest for the CMB B-mode polarization.Comment: Latest CMB results have been included. References added. To appear in "Highlights of Spanish Astrophysics V", Proceedings of the VIII Scientific Meeting of the Spanish Astronomical Society (SEA) held in Santander, 7-11 July, 200

Predicting consumer biomass, size-structure, production, catch potential, responses to fishing and associated uncertainties in the world's marine ecosystems

Existing estimates of fish and consumer biomass in the world’s oceans are disparate. This creates uncertainty about the roles of fish and other consumers in biogeochemical cycles and ecosystem processes, the extent of human and environmental impacts and fishery potential. We develop and use a size-based macroecological model to assess the effects of parameter uncertainty on predicted consumer biomass, production and distribution. Resulting uncertainty is large (e.g. median global biomass 4.9 billion tonnes for consumers weighing 1 g to 1000 kg; 50% uncertainty intervals of 2 to 10.4 billion tonnes; 90% uncertainty intervals of 0.3 to 26.1 billion tonnes) and driven primarily by uncertainty in trophic transfer efficiency and its relationship with predator-prey body mass ratios. Even the upper uncertainty intervals for global predictions of consumer biomass demonstrate the remarkable scarcity of marine consumers, with less than one part in 30 million by volume of the global oceans comprising tissue of macroscopic animals. Thus the apparently high densities of marine life seen in surface and coastal waters and frequently visited abundance hotspots will likely give many in society a false impression of the abundance of marine animals. Unexploited baseline biomass predictions from the simple macroecological model were used to calibrate a more complex size- and trait-based model to estimate fisheries yield and impacts. Yields are highly dependent on baseline biomass and fisheries selectivity. Predicted global sustainable fisheries yield increases ≈4 fold when smaller individuals (< 20 cm from species of maximum mass < 1kg) are targeted in all oceans, but the predicted yields would rarely be accessible in practice and this fishing strategy leads to the collapse of larger species if fishing mortality rates on different size classes cannot be decoupled. Our analyses show that models with minimal parameter demands that are based on a few established ecological principles can support equitable analysis and comparison of diverse ecosystems. The analyses provide insights into the effects of parameter uncertainty on global biomass and production estimates, which have yet to be achieved with complex models, and will therefore help to highlight priorities for future research and data collection. However, the focus on simple model structures and global processes means that non-phytoplankton primary production and several groups, structures and processes of ecological and conservation interest are not represented. Consequently, our simple models become increasingly less useful than more complex alternatives when addressing questions about food web structure and function, biodiversity, resilience and human impacts at smaller scales and for areas closer to coasts

Genome-wide gene expression profiling of testicular carcinoma in situ progression into overt tumours

The carcinoma in situ (CIS) cell is the common precursor of nearly all testicular germ cell tumours (TGCT). In a previous study, we examined the gene expression profile of CIS cells and found many features common to embryonic stem cells indicating that initiation of neoplastic transformation into CIS occurs early during foetal life. Progression into an overt tumour, however, typically first happens after puberty, where CIS cells transform into either a seminoma (SEM) or a nonseminoma (N-SEM). Here, we have compared the genome-wide gene expression of CIS cells to that of testicular SEM and a sample containing a mixture of N-SEM components, and analyse the data together with the previously published data on CIS. Genes showing expression in the SEM or N-SEM were selected, in order to identify gene expression markers associated with the progression of CIS cells. The identified markers were verified by reverse transcriptase–polymerase chain reaction and in situ hybridisation in a range of different TGCT samples. Verification showed some interpatient variation, but combined analysis of a range of the identified markers may discriminate TGCT samples as SEMs or N-SEMs. Of particular interest, we found that both DNMT3B (DNA (cytosine-5-)-methyltransferase 3 beta) and DNMT3L (DNA (cytosine-5-)-methyltransferase 3 like) were overexpressed in the N-SEMs, indicating the epigenetic differences between N-SEMs and classical SEM