Leveraging National Reports to Transform Ambulatory Care Practice

Multiple national reports identify actionable recommendations to transform education and practice to meet the needs of health care and healthcare delivery beyond the hospital walls. The Josiah Macy Jr. Conference (2016) focused on transforming primary care and changing healthcare culture to support expansion of roles for registered nurses (RNs). Partnerships between academia and clinical practice are critical to expanding learning opportunities beyond traditional acute care settings. Development of primary care expertise in nursing faculty and adjunct faculty, in collaboration with primary care and ambulatory care nursing leaders, is essential. Academic-practice partnerships must advocate for removing regulatory and practice barriers to allow RNs to practice to the full scope of education and training. Recommendations from national reports extend beyond enhanced roles in primary care practice and have global implication

Integrating Correctional and Community Health Care: An Innovative Approach for Clinical Learning in a Baccalaureate Nursing Program.

PROBLEM: With an evolving focus on primary, community-based, and patient-centered care rather than acute, hospital-centric, disease-focused care, and recognition of the importance of coordinating care and managing transitions across providers and settings of care, registered nurses need to be prepared from a different and broader knowledge base and skills set. A culture change among nurse educators and administrators and in nursing education is needed to prepare competent registered nurses capable of practicing from a health promotion, disease prevention, community- and population-focused construct in caring for a population of patients who are presenting health problems and conditions that persist across decades and/or lifetimes. While healthcare delivery is moving from the hospital to ambulatory and community settings, community-based educational opportunities for nursing students are shrinking due to a variety of reasons, including but not limited to increased regulatory requirements, the presence of competing numbers of nursing schools and their increased enrollment of students, and decreasing availability of community resources capable and willing to precept students in an all-day interactive learning environment. METHODS: A detailed discussion of one college of nursings\u27 journey to find an innovative solution and approach to the dilemma of limited and decreasing available community clinical sites to prepare senior level prelicensure baccalaureate nursing students for healthcare practice in the twenty-first century. FINDINGS: This article demonstrated how medium/maximum prisons can provide an ideal learning experience for not only technical nursing skills but more importantly for reinforcing key learning goals for community-based care, raising population-based awareness, and promoting cultural awareness and sensitivity. In addition, this college of nursing overcame the challenges of initiating and maintaining clinical placement in a prison facility, collaboratively developed strategies to insure student and faculty safety satisfying legal and administrative concerns for both the college of nursing and the prison, and developed educational postclinical assignments that solidified clinical course and nursing program objectives. Lastly, this college of nursing quickly learned that not only did nursing students agree to clinical placement in an all-male medium- to maximum-security prison despite its accompanying restrictive regulations especially as it relates to their access to personal technology devices, but there was an unknown desire for a unique clinical experience. CONCLUSION: The initial pilot program of placing eight senior level prelicensure baccalaureate nursing students in a 4,000-person all male medium- to maximum-security prison for their community clinical rotation has expanded to include three state-run maximum all male prisons in two states, a 3,000-person male/female federal prison, and several juvenile detention centers. Clinical placement of students in these sites is by request only, resulting in lengthy student waiting lists. This innovative approach to clinical learning has piqued the interest of graduate nurse practitioner (NP) students as well. One MSN, NP student has been placed in the federal prison every semester for over a year. Due to increasing interest from graduate students to learn correctional health nursing, the college of nursing is now expanding NP placement to the other contracted maximum-security prisons. This entire experience has changed clinical policies within a well-established academic culture and promoted creative thinking regarding how and where to clinically educate and prepare registered baccalaureate nurses for the new culture of health and wellness

Negative Entropy of Mixing for Vanadium-Platinum Solutions

The phonon densities of states for pure vanadium and the solid solutions V-6.25% Ni, Pd, Pt were determined from inelastic neutron scattering measurements. The solute atoms caused a large stiffening of the phonons, resulting in large, negative vibrational entropies of mixing. For V-6.25%Pt, the negative vibrational entropy of mixing exceeds the conventional positive chemical entropy of mixing. This negative total entropy of mixing should extend to lower concentrations of Pt, and the effect on the bcc solvus line is discussed. The experimental data were inverted to obtain interatomic force constants by using a Born–von Kármán model with an iterative optimization algorithm. The stiffening of bonds responsible for the decrease of entropy was found to occur mainly in first-nearest-neighbor solute-host bonds, and correlates in part with the solute metallic radius

An analysis of short haul air passenger demand, volume 2

Several demand models for short haul air travel are proposed and calibrated on pooled data. The models are designed to predict demand and analyze some of the motivating phenomena behind demand generation. In particular, an attempt is made to include the effects of competing modes and of alternate destinations. The results support three conclusions: (1) the auto mode is the air mode's major competitor; (2) trip time is an overriding factor in intermodal competition, with air fare at its present level appearing unimportant to the typical short haul air traveler; and (3) distance appears to underly several demand generating phenomena, and therefore, must be considered very carefully to any intercity demand model. It may be the cause of the wide range of fare elasticities reported by researchers over the past 15 years. A behavioral demand model is proposed and calibrated. It combines the travel generating effects of income and population, the effects of modal split, the sensitivity of travel to price and time, and the effect of alternative destinations satisfying the trip purpose

A Retrospective Analysis of Nursing Students\u27 Clinical Experience in an All-Male Maximum Security Prison.

Prisons provide an ideal learning experience to prepare prelicensure students with the knowledge and skill set needed for practice in the 21st century. Beginning descriptive evidence demonstrates that correctional health is an innovative community resource to educate nursing students in today\u27s changing model of health care delivery and practice. This article shares results from a retrospective analysis of the perceptions and experiences of nursing students during their community clinical rotation in an all-male maximum security prison

Phonon entropy of alloying and ordering of Cu-Au

Inelastic neutron scattering spectra were measured with a time-of-flight spectrometer on six disordered Cu-Au alloys at 300 K. The neutron-weighted phonon density of states was obtained from a conventional analysis of these spectra. Several methods were developed to account for this neutron weighting and obtain the phonon entropy of the disordered alloys. The phonon entropies of formation of disordered fcc Cu-Au alloys obtained in this way were generally mutually consistent, and were also consistent with predictions from a cluster approximation obtained from ab-initio calculations by Ozolin[underaccent cedilla [below] s-breve, Wolverton, and Zunger. We estimate a phonon entropy of disordering of 0.15±0.05kB/atom in Cu3Au at 300 K. A resonance mode associated with the motions of the heavy Au atoms in the Cu-rich alloys was observed at 9 meV. An analysis of the resonance mode provided a check on the partial phonon entropy of Au atoms

The unbiased frequency of planetary signatures around single and binary white dwarfs using Spitzer{\it Spitzer} and Hubble{\it Hubble}

This paper presents combined ${\it Spitzer}$ IRAC and ${\it Hubble}$ COS results for a double-blind survey of 195 single and 22 wide binary white dwarfs for infrared excesses and atmospheric metals. The selection criteria include cooling ages in the range 9 to 300 Myr, and hydrogen-rich atmospheres so that the presence of atmospheric metals can be confidently linked to ongoing accretion from a circumstellar disc. The entire sample has infrared photometry, whereas 168 targets have corresponding ultraviolet spectra. Three stars with infrared excesses due to debris discs are recovered, yielding a nominal frequency of $1.5_{-0.5}^{+1.5}$ per cent, while in stark contrast, the fraction of stars with atmospheric metals is $45\pm4$ per cent. Thus, only one out of 30 polluted white dwarfs exhibits an infrared excess at 3-4 $\mu$m in IRAC photometry, which reinforces the fact that atmospheric metal pollution is the most sensitive tracer of white dwarf planetary systems. The corresponding fraction of infrared excesses around white dwarfs with wide binary companions is consistent with zero, using both the infrared survey data and an independent assessment of potential binarity for well-established dusty and polluted stars. In contrast, the frequency of atmospheric pollution among the targets in wide binaries is indistinct from apparently single stars, and moreover the multiplicity of polluted white dwarfs in a complete and volume-limited sample is the same as for field stars. Therefore, it appears that the delivery of planetesimal material onto white dwarfs is ultimately not driven by stellar companions, but by the dynamics of planetary bodies.Comment: 15 pages, 6 figures, 3 tables; accepted for publication in MNRA

New approaches for estimating risk from exposure to diethylstilbestrol.

A subgroup from a National Institute of Environmental Health Sciences, workshop concerned with characterizing the effects of endocrine disruptors on human health at environmental exposure levels considered the question, If diethylstilbestrol (DES) were introduced into the market for human use today and likely to result in low-dose exposure of the human fetus, what would be required to assess risk? On the basis of an analysis of the quality of data on human DES exposure, the critical times and doses for inducing genital tract malformations and cancer must be determined. This would be facilitated through analysis of the ontogeny of estrogen receptor expression in the developing human genital tract. Models of low-dose estrogenic effects will have to be developed for human and rodent genital tract development. Mouse models offer many advantages over other potential animal models because of the wealth of the earlier literature, the availability of sensitive end points, the availability of mutant lines, and the possibility of generating genetically engineered model systems. Through multidisciplinary approaches, it should be possible to elucidate the cellular and molecular mechanisms of endocrine disruption elicited by estrogens during development and facilitate an assessment of risk to humans

Dynkin isomorphism and mermin-wagner theorems for hyperbolic sigma models and recurrence of the two-dimensional vertex-reinforced jump process

We prove the vertex-reinforced jump process (VRJP) is recurrent in two dimensions for any translation invariant finite range initial rates. Our proof has two main ingredients. The first is a direct connection between the VRJP and sigma models whose target space is a hyperbolic space $\mathbb{H}^n$ or its supersymmetric counterpart $\mathbb{H}^{2|2}$. These results are analogues of well-known relations between the Gaussian free field and the local times of simple random walk. The second ingredient is a Mermin--Wagner theorem for these sigma models. This result is of intrinsic interest for the sigma models and also implies our main theorem on the VRJP. Surprisingly, our Mermin--Wagner theorem applies even though the symmetry groups of $\mathbb{H}^n$ and $\mathbb{H}^{2|2}$ are non-amenable