Perceptions of Preparedness Among New Graduate Nurses: Traditional Curriculum Versus Concept-Based Curriculum

Concept-based curriculum (CBC) is a newer trend in nursing education curriculum aimed at preparing new graduates to enter the workforce as generalist nurses better suited to care for a more medically complex population. Using CBC, students are introduced to concepts in order to build conceptual understandings as they engage in knowledge and skill learning, as opposed to a traditional nursing curriculum that is taught in sections grouped by patient population and medical complexity. At a nursing school housed within a private university in the southeast, the traditional nursing curriculum was replaced with CBC in 2016. To better understand the preparedness of new graduate nurses, students graduating from both traditional curriculum and CBC curricular designs were asked about their perception of preparedness in five specific areas during their first three months of clinical practice. The results of the explanatory mixed-methods survey, which consisted of Likert scale responses and qualitative data, showed no statistically significant difference in perception of preparedness between the two groups. The outcomes of each individual curricula were not dramatically different, but the actionable data reinforces the importance of clinical learning

The Role of Critical Case Analysis in Interprofessional Education

Goals for interprofessional education include preparing students to work in collaborative practice, teaching them how to work in teams and to asses and improve the quality of patient care. (Barr, 2007, Thibault, 2013). Four core competency domains have been established to inform interprofessional education (Interprofessional Education Collaborative Expert Panel, 2011). These are ethics/values, roles/responsibilities, interprofessional communication and teams/teamwork. Various pedagogical approaches have been used to help students meet these competencies. The Josiah Macy, Jr. Foundation (2013) recommends development and implementation of innovative models to link interprofessional education and practice. Thibault (2013) recommends students engage in “real work” as part of their interprofessional education experience

The Dark Side of ROTSE-III Prompt GRB Observations

We present several cases of optical observations during gamma-ray bursts (GRBs) which resulted in prompt limits but no detection of optical emission. These limits constrain the prompt optical flux densities and the optical brightness relative to the gamma-ray emission. The derived constraints fall within the range of properties observed in GRBs with prompt optical detections, though at the faint end of optical/gamma flux ratios. The presently accessible prompt optical limits do not require a different set of intrinsic or environmental GRB properties, relative to the events with prompt optical detections.Comment: ApJ accepted. 20 pages in draft manuscript form, which includes 6 pages of tables and 2 figure

Value of Strain Imaging and Maximal Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy

Longitudinal strain (LS) has been shown to be predictive of outcome in hypertrophic cardiomyopathy (HC). Percent predicted peak oxygen uptake (ppVO2), among other cardiopulmonary exercise testing (CPX) metrics, is a strong predictor of prognosis in HC. However, there has been limited investigation into the combination of LS and CPX metrics. This study sought to determine how LS and parameters of exercise performance contribute to prognosis in HC. One hundred and thirty-one consecutive patients with HC who underwent CPX and stress echocardiography were included. Global, septal, and lateral LS were assessed at rest and stress. Eighty matched individuals were used as controls. Patients were followed for the composite end point of death and worsening heart failure. All absolute LS components were lower in patients with HC than in controls (global 14.3\u2009\ub1\u20094.0% vs 18.8\u2009\ub1\u20092.2%, p 52\u2009ml/m2, and ppVO2 <80%. The combination of lateral LS, LAVI, and ppVO2 presents a simple model for outcome prediction

Angiotensin-Converting Enzyme Genotype Predicts Cardiac and Autonomic Responses to Prolonged Exercise

ObjectivesThe purpose of this study was to investigate the phenomenon of left ventricular (LV) dysfunction after ultraendurance exercise.BackgroundSubclinical LV dysfunction in response to endurance exercise up to 24 h duration has been described, but its mechanism remains elusive.MethodsWe tested 86 athletes before and after the Adrenalin Rush Adventure Race using echocardiography, impedance cardiography, and plasma immunoassay.ResultsAt baseline, athletes demonstrated physiology characteristic of extreme endurance training. After 90 to 120 h of almost-continuous exercise, LV systolic and diastolic function declined (fractional shortening before the race, 39.6 ± 0.65%; after, 32.2 ± 0.84%, p < 0.001; mitral inflow E-wave deceleration time before the race, 133 ± 5 ms; after, 160 ± 5 ms, n = 48, p < 0.001) without change in loading conditions as defined by LV end-diastolic dimension and total peripheral resistance estimated by thoracic impedance. There was a compensatory increase in heart rate (before, 55 ± 1.3 beats/min; after, 59 ± 1.5 beats/min, p = 0.05), which left cardiac output unchanged, as well as significant-but-subclinical increases in brain natriuretic peptide and troponin I. In addition, we found that athletes who were homozygous for the intron-16 insertion polymorphism of the angiotensin-converting enzyme (ACE) gene exhibited a significantly greater decrease in fractional shortening than athletes who were homozygous for the deletion allele. Heterozygotes showed an intermediate phenotype. In addition, the deletion group manifest an enhanced sympathovagal balance after the race, as evidenced by greater power in the low-frequency component of blood pressure variability.ConclusionsThe ACE genotype predicts the extent of reversible subclinical LV dysfunction after prolonged exercise and is associated with a differential postactivity augmentation of sympathetic nervous system function that may explain it

Prompt Optical Detection of GRB 050401 with ROTSE-IIIa

The ROTSE-IIIa telescope at Siding Spring Observatory, Australia, detected prompt optical emission from Swift GRB 050401. In this letter, we present observations of the early optical afterglow, first detected by the ROTSE-IIIa telescope 33 s after the start of gamma-ray emission, contemporaneous with the brightest peak of this emission. This GRB was neither exceptionally long nor bright. This is the first prompt optical detection of a GRB of typical duration and luminosity. We find that the early afterglow decay does not deviate significantly from the power-law decay observable at later times, and is uncorrelated with the prompt gamma-ray emission. We compare this detection with the other two GRBs with prompt observations, GRB 990123 and GRB 041219a. All three bursts exhibit quite different behavior at early times.Comment: 4 pages, 3 figures. Accepted for publication in ApJ Letter

Status of the ROTSE-III telescope network

ROTSE-III is a homogeneous worldwide array of 4 robotic telescopes. They were designed to provide optical observations of γ-ray burst (GRB) afterglows as close as possible to the start of γ-ray emission. ROTSE-III is fulfilling its potential for GRB science, and provides optical observations for a variety of astrophysical sources in the interim between GRB events

The Anomalous Early Afterglow of GRB 050801

The ROTSE-IIIc telescope at the H.E.S.S. site, Namibia, obtained the earliest detection of optical emission from a Gamma-Ray Burst (GRB), beginning only 21.8 s from the onset of Swift GRB 050801. The optical lightcurve does not fade or brighten significantly over the first ~250 s, after which there is an achromatic break and the lightcurve declines in typical power-law fashion. The Swift/XRT also obtained early observations starting at 69 s after the burst onset. The X-ray lightcurve shows the same features as the optical lightcurve. These correlated variations in the early optical and X-ray emission imply a common origin in space and time. This behavior is difficult to reconcile with the standard models of early afterglow emission.Comment: 5 pages, 1 figure. Accepted for publication in ApJ Letter

Optical Lightcurve & Cooling Break of GRB 050502A

We present lightcurves of the afterglow of GRB050502A, including very early data at t-t_{GRB} < 60s. The lightcurve is composed of unfiltered ROTSE-IIIb optical observations from 44s to 6h post-burst, R-band MDM observations from 1.6 to 8.4h post-burst, and PAIRITEL J H K_s observations from 0.6 to 2.6h post-burst. The optical lightcurve is fit by a broken power law, where t^{alpha} steepens from alpha = -1.13 +- 0.02 to alpha = -1.44 +- 0.02 at \~5700s. This steepening is consistent with the evolution expected for the passage of the cooling frequency nu_c through the optical band. Even in our earliest observation at 44s post-burst, there is no evidence that the optical flux is brighter than a backward extrapolation of the later power law would suggest. The observed decay indices and spectral index are consistent with either an ISM or a Wind fireball model, but slightly favor the ISM interpretation. The expected spectral index in the ISM interpretation is consistent within 1 sigma with the observed spectral index beta = -0.8 +- 0.1; the Wind interpretation would imply a slightly (~2 sigma) shallower spectral index than observed. A small amount of dust extinction at the source redshift could steepen an intrinsic spectrum sufficiently to account for the observed value of beta. In this picture, the early optical decay, with the peak at or below 4.7e14 Hz at 44s, requires very small electron and magnetic energy partitions from the fireball.Comment: 22 pages, including 3 tables and 1 figure, Accepted by Ap